Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	2692146
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	2692146
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

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	366899151
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	5100848
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	5100848
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

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	5792285
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	366899151
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

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	5792285
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

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	321099151
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	$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

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	321099151
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

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	5100849
Hospital Revenue Code	370
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.50
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	2500265
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	2500265
Hospital Revenue Code	370
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.50
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	321099152
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	7412070
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	2692141
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	7412070
Hospital Revenue Code	370
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.50
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	321099152
Hospital Revenue Code	370
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.50
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	2692141
Hospital Revenue Code	370
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.50
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	5100849
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	5792286
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	5792286
Hospital Revenue Code	370
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.50
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	366899152
Hospital Revenue Code	370
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$33.65
Rate for Payer: Aetna Commercial	$25.57
Rate for Payer: Aetna Medicare Advantage	$20.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.50
Rate for Payer: Oxford Commercial	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.10
Rate for Payer: UnitedHealthcare Commercial	$13.46
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

MOD SED SAME MD >5YO 1ST 15MIN

Facility

$67.30

Service Code	HCPCS 99152
Hospital Charge Code	366899152
Hospital Revenue Code	370
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$10.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.10

Know your out-of-pocket cost for care.

All Charges