Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	485599244
Hospital Revenue Code	510
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$405.92
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.73
Rate for Payer: Qualcare PPO/HMO/WC	$160.23
Rate for Payer: UnitedHealthcare Community & State	$33.76
Rate for Payer: Wellpoint Medicaid Managed Care	$30.34

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	421599244
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

LEVEL 5 GRS & MICRO EXAM

Facility

$1,099.00

Service Code	HCPCS 88307
Hospital Charge Code	38474052
Hospital Revenue Code	310
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$1,544.73
Rate for Payer: Aetna Commercial	$1,158.28
Rate for Payer: Aetna Medicare Advantage	$1,379.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,544.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,544.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$425.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,544.73
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$425.84
Rate for Payer: Clover Medicare Advantage	$404.55
Rate for Payer: EmblemHealth Commercial	$1,277.52
Rate for Payer: Humana Medicare Advantage	$438.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$425.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$235.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$31.21

LEVEL 5 GRS & MICRO EXAM

Facility

$1,099.00

Service Code	HCPCS 88307
Hospital Charge Code	38474052
Hospital Revenue Code	310
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$164.85
Rate for Payer: Qualcare PPO/HMO/WC	$164.85

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	485599245
Hospital Revenue Code	510
Min. Negotiated Rate	$41.18
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$45.82
Rate for Payer: Wellpoint Medicaid Managed Care	$41.18

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421599245
Hospital Revenue Code	510
Min. Negotiated Rate	$41.18
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$45.82
Rate for Payer: Wellpoint Medicaid Managed Care	$41.18

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	485599245
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421099245
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421099245
Hospital Revenue Code	510
Min. Negotiated Rate	$41.18
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$45.82
Rate for Payer: Wellpoint Medicaid Managed Care	$41.18

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421599245
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 6 GRS & MICRO EXAM

Facility

$2,184.00

Service Code	HCPCS 88309
Hospital Charge Code	38474055
Hospital Revenue Code	310
Min. Negotiated Rate	$62.03
Max. Negotiated Rate	$3,472.13
Rate for Payer: Aetna Commercial	$2,603.50
Rate for Payer: Aetna Medicare Advantage	$3,101.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,472.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,472.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$957.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,472.13
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$957.17
Rate for Payer: Clover Medicare Advantage	$909.31
Rate for Payer: EmblemHealth Commercial	$2,871.51
Rate for Payer: Humana Medicare Advantage	$985.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$567.84
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$327.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$352.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$957.17
Rate for Payer: Wellcare Medicare Advantage	$957.17
Rate for Payer: Wellpoint Medicaid Managed Care	$62.03

LEVEL 6 GRS & MICRO EXAM

Facility

$2,184.00

Service Code	HCPCS 88309
Hospital Charge Code	38474055
Hospital Revenue Code	310
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$327.60
Rate for Payer: Qualcare PPO/HMO/WC	$327.60

LEVEL II-GRS/MICRO EXAM

Facility

$418.00

Service Code	HCPCS 88302
Hospital Charge Code	38474043
Hospital Revenue Code	310
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

LEVEL II-GRS/MICRO EXAM

Facility

$418.00

Service Code	HCPCS 88302
Hospital Charge Code	38474043
Hospital Revenue Code	310
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$160.95
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$27.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$11.87

LEVELIII,GRS & MICRO EXAM

Facility

$873.60

Service Code	HCPCS 88304
Hospital Charge Code	38474046
Hospital Revenue Code	310
Min. Negotiated Rate	$24.81
Max. Negotiated Rate	$227.14
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.58
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.04
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$35.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$24.81

LEVELIII,GRS & MICRO EXAM

Facility

$873.60

Service Code	HCPCS 88304
Hospital Charge Code	38474046
Hospital Revenue Code	310
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$131.04
Rate for Payer: Qualcare PPO/HMO/WC	$131.04

LEVEL III SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88304TC
Hospital Charge Code	3005291
Hospital Revenue Code	312
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEVEL III SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88304TC
Hospital Charge Code	3005291
Hospital Revenue Code	312
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LEVEL III SP GROSS&MICROSCOPIC

Facility

$873.60

Service Code	HCPCS 88304TC
Hospital Charge Code	3005290
Hospital Revenue Code	310
Min. Negotiated Rate	$24.81
Max. Negotiated Rate	$436.80
Rate for Payer: Aetna Commercial	$331.97
Rate for Payer: Aetna Medicare Advantage	$262.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$222.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$222.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$222.77
Rate for Payer: Cigna Commercial	$436.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.04
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$27.61
Rate for Payer: Wellpoint Medicaid Managed Care	$24.81

LEVEL III SP GROSS&MICROSCOPIC

Facility

$873.60

Service Code	HCPCS 88304TC
Hospital Charge Code	3005290
Hospital Revenue Code	310
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$131.04
Rate for Payer: Qualcare PPO/HMO/WC	$131.04

LEVEL II SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88302TC
Hospital Charge Code	3005286
Hospital Revenue Code	312
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEVEL II SP GROSS&MICROSCOPIC

Facility

$418.00

Service Code	HCPCS 88302TC
Hospital Charge Code	3005285
Hospital Revenue Code	310
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$209.00
Rate for Payer: Aetna Commercial	$158.84
Rate for Payer: Aetna Medicare Advantage	$125.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.59
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.21
Rate for Payer: Wellpoint Medicaid Managed Care	$11.87

LEVEL II SP GROSS&MICROSCOPIC

Facility

$390.00

Service Code	HCPCS 88302TC
Hospital Charge Code	3005286
Hospital Revenue Code	312
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LEVEL II SP GROSS&MICROSCOPIC

Facility

$418.00

Service Code	HCPCS 88302TC
Hospital Charge Code	3005285
Hospital Revenue Code	310
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

LEVEL I SP GROSS&MICROSCOPIC

Facility

$465.00

Service Code	HCPCS 88300
Hospital Charge Code	3005280
Hospital Revenue Code	310
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$69.75
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

Know your out-of-pocket cost for care.

All Charges