Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4527501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4832501
Hospital Revenue Code	914
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4509501
Hospital Revenue Code	914
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4822501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4822501
Hospital Revenue Code	914
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4504501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4504501
Hospital Revenue Code	914
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4535501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4515501
Hospital Revenue Code	914
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4517501
Hospital Revenue Code	914
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4546501
Hospital Revenue Code	914
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4546501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4517501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84509049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$550.00

Service Code	HCPCS 90785
Hospital Charge Code	87504130
Hospital Revenue Code	900
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$3,080.00
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	$4.80
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: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84517049
Hospital Revenue Code	900
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: Aetna Medicare Advantage	$22.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.44
Rate for Payer: Cigna Commercial	$38.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.82
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.44
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84518049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84509049
Hospital Revenue Code	900
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: Aetna Medicare Advantage	$22.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.44
Rate for Payer: Cigna Commercial	$38.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.82
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.44
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

INTERACTIVE COMPLEXITY

Facility

$6,800.00

Service Code	HCPCS 90785
Hospital Charge Code	83246150
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

INTERACTIVE COMPLEXITY

Facility

$6,800.00

Service Code	HCPCS 90785
Hospital Charge Code	83246150
Hospital Revenue Code	900
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$3,400.00
Rate for Payer: Aetna Commercial	$2,584.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$3,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,768.00
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$214.88
Rate for Payer: Wellpoint Medicaid Managed Care	$193.12

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84517049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84511049
Hospital Revenue Code	900
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: Aetna Medicare Advantage	$22.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.44
Rate for Payer: Cigna Commercial	$38.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.82
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.44
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84511049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84518049
Hospital Revenue Code	900
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: Aetna Medicare Advantage	$22.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.44
Rate for Payer: Cigna Commercial	$38.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.82
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.44
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

INTERACTIVE COMPLEXITY

Facility

$550.00

Service Code	HCPCS 90785
Hospital Charge Code	87504130
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

Know your out-of-pocket cost for care.

All Charges