Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	2692144
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	2500268
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	5100852
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	321099156
Hospital Revenue Code	370
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$155.69
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$204.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.52
Rate for Payer: Oxford Commercial	$81.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$81.94
Rate for Payer: UnitedHealthcare Community & State	$12.95
Rate for Payer: Wellpoint Medicaid Managed Care	$11.64

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	2692144
Hospital Revenue Code	370
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$155.69
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$204.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.52
Rate for Payer: Oxford Commercial	$81.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$81.94
Rate for Payer: UnitedHealthcare Community & State	$12.95
Rate for Payer: Wellpoint Medicaid Managed Care	$11.64

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	7412073
Hospital Revenue Code	370
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$155.69
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$204.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.52
Rate for Payer: Oxford Commercial	$81.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$81.94
Rate for Payer: UnitedHealthcare Community & State	$12.95
Rate for Payer: Wellpoint Medicaid Managed Care	$11.64

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	7412074
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2692147
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	7412074
Hospital Revenue Code	370
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.80
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$9.82
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2692147
Hospital Revenue Code	370
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.80
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$9.82
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2500269
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5100853
Hospital Revenue Code	370
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.80
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$9.82
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2500269
Hospital Revenue Code	370
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.80
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$9.82
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5792290
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5792290
Hospital Revenue Code	370
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.80
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$9.82
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	321099157
Hospital Revenue Code	370
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.80
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$9.82
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5100853
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	321099157
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED OTHER PHYS/QHP EA

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	366899157
Hospital Revenue Code	370
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$118.08
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$155.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.80
Rate for Payer: Oxford Commercial	$62.15
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$62.15
Rate for Payer: UnitedHealthcare Community & State	$9.82
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

MOD SED OTHER PHYS/QHP EA

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	366899157
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED OTH PHYS/QHP 5/>YRS

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	366899156
Hospital Revenue Code	370
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$155.69
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$204.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.52
Rate for Payer: Oxford Commercial	$81.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$81.94
Rate for Payer: UnitedHealthcare Community & State	$12.95
Rate for Payer: Wellpoint Medicaid Managed Care	$11.64

MOD SED OTH PHYS/QHP 5/>YRS

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	366899156
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	2500264
Hospital Revenue Code	370
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$19.19

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	7412069
Hospital Revenue Code	370
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$19.19

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	2500264
Hospital Revenue Code	370
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$63.98
Rate for Payer: Aetna Commercial	$48.62
Rate for Payer: Aetna Medicare Advantage	$38.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.63
Rate for Payer: Cigna Commercial	$63.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.27
Rate for Payer: Oxford Commercial	$25.59
Rate for Payer: Qualcare PPO/HMO/WC	$19.19
Rate for Payer: UnitedHealthcare Commercial	$25.59
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

Know your out-of-pocket cost for care.

All Charges