Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$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	4502719
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	4502719
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

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	87506090
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

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4518719
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	4517719
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	4518719
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	$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	4517719
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	93950151
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	4824719
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

ESTBLISH PAT OV-LIMITED

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	83653185
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

ESTBLISH PAT OV-LIMITED

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	83653185
Hospital Revenue Code	514
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTECH FEM VASC DILATOR KIT

Facility

$1,000.00

Hospital Charge Code	2703110Y
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ESTECH FEM VASC DILATOR KIT

Facility

$1,000.00

Hospital Charge Code	2703110Y
Hospital Revenue Code	272
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

ESTECH FEM VEN CANN 23/25

Facility

$2,025.00

Hospital Charge Code	2703110W
Hospital Revenue Code	272
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$303.75
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

ESTECH FEM VEN CANN 23/25

Facility

$2,025.00

Hospital Charge Code	2703110W
Hospital Revenue Code	272
Min. Negotiated Rate	$57.51
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$769.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.50
Rate for Payer: Oxford Commercial	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$303.75
Rate for Payer: UnitedHealthcare Commercial	$405.00
Rate for Payer: UnitedHealthcare Community & State	$63.99
Rate for Payer: Wellpoint Medicaid Managed Care	$57.51

E- STIM UNATTENDED/CHRONIC STA

Facility

$91.00

Service Code	HCPCS G0281GO
Hospital Charge Code	74203081
Hospital Revenue Code	430
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$34.58
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.66
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

E- STIM UNATTENDED/CHRONIC STA

Facility

$91.00

Service Code	HCPCS G0281GO
Hospital Charge Code	74203081
Hospital Revenue Code	430
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

E-STIM UNATTENDED CQ

Facility

$91.25

Service Code	HCPCS G0281GP
Hospital Charge Code	904170281Q
Hospital Revenue Code	420
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.73
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.59

E-STIM UNATTENDED CQ

Facility

$91.25

Service Code	HCPCS G0281GP
Hospital Charge Code	904170281Q
Hospital Revenue Code	420
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

E-STIM UNATTENDED NON WND CQ

Facility

$91.25

Service Code	HCPCS G0283GP
Hospital Charge Code	904170283Q
Hospital Revenue Code	420
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

E-STIM UNATTENDED NON WND CQ

Facility

$91.25

Service Code	HCPCS G0283GP
Hospital Charge Code	904170283Q
Hospital Revenue Code	420
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.73
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.59

ESTRADIOL

Facility

$941.00

Service Code	HCPCS 82670
Hospital Charge Code	38472260
Hospital Revenue Code	301
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$470.50
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.35
Rate for Payer: Cigna Commercial	$470.50
Rate for Payer: Cigna Medicare Advantage	$27.94
Rate for Payer: Clover Medicare Advantage	$26.54
Rate for Payer: EmblemHealth Commercial	$83.82
Rate for Payer: Humana Medicare Advantage	$28.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$141.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$22.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.94
Rate for Payer: Wellcare Medicare Advantage	$27.94
Rate for Payer: Wellpoint Medicaid Managed Care	$26.72

ESTRADIOL

Facility

$941.00

Service Code	HCPCS 82670
Hospital Charge Code	38472260
Hospital Revenue Code	301
Min. Negotiated Rate	$141.15
Max. Negotiated Rate	$141.15
Rate for Payer: Qualcare PPO/HMO/WC	$141.15

Know your out-of-pocket cost for care.

All Charges