Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4510714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4504714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	87502220
Hospital Revenue Code	510
Min. Negotiated Rate	$28.49
Max. Negotiated Rate	$501.50
Rate for Payer: Aetna Commercial	$381.14
Rate for Payer: Aetna Medicare Advantage	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.76
Rate for Payer: Cigna Commercial	$501.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.78
Rate for Payer: Qualcare PPO/HMO/WC	$150.45
Rate for Payer: UnitedHealthcare Community & State	$31.69
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,450.00

Service Code	HCPCS 99205
Hospital Charge Code	485099205
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	84208260
Hospital Revenue Code	510
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$150.45
Rate for Payer: Qualcare PPO/HMO/WC	$150.45

NEW PATIENT LEV 5 >=60 MINS

Facility

$877.65

Service Code	HCPCS 99205
Hospital Charge Code	87506060
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	74308290
Hospital Revenue Code	514
Min. Negotiated Rate	$28.49
Max. Negotiated Rate	$501.50
Rate for Payer: Aetna Commercial	$381.14
Rate for Payer: Aetna Medicare Advantage	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.76
Rate for Payer: Cigna Commercial	$501.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.78
Rate for Payer: Qualcare PPO/HMO/WC	$150.45
Rate for Payer: UnitedHealthcare Community & State	$31.69
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

NEW PATIENT LEV 5 >=60 MINS

Facility

$877.65

Service Code	HCPCS 99205
Hospital Charge Code	87506060
Hospital Revenue Code	513
Min. Negotiated Rate	$24.93
Max. Negotiated Rate	$438.82
Rate for Payer: Aetna Commercial	$333.51
Rate for Payer: Aetna Medicare Advantage	$263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.80
Rate for Payer: Cigna Commercial	$438.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.19
Rate for Payer: Qualcare PPO/HMO/WC	$131.65
Rate for Payer: UnitedHealthcare Community & State	$27.73
Rate for Payer: Wellpoint Medicaid Managed Care	$24.93

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	74308290
Hospital Revenue Code	514
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$150.45
Rate for Payer: Qualcare PPO/HMO/WC	$150.45

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	84208260
Hospital Revenue Code	510
Min. Negotiated Rate	$28.49
Max. Negotiated Rate	$501.50
Rate for Payer: Aetna Commercial	$381.14
Rate for Payer: Aetna Medicare Advantage	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.76
Rate for Payer: Cigna Commercial	$501.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.78
Rate for Payer: Qualcare PPO/HMO/WC	$150.45
Rate for Payer: UnitedHealthcare Community & State	$31.69
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4518714
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	$151.22
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: Wellpoint Medicaid Managed Care	$17.04

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4515714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4511714
Hospital Revenue Code	914
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	$151.22
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: Wellpoint Medicaid Managed Care	$17.04

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4518714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4509714
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	$151.22
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: Wellpoint Medicaid Managed Care	$17.04

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4535714
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	$151.22
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: Wellpoint Medicaid Managed Care	$17.04

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4546714
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	$151.22
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: Wellpoint Medicaid Managed Care	$17.04

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	87502220
Hospital Revenue Code	510
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$150.45
Rate for Payer: Qualcare PPO/HMO/WC	$150.45

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4502714
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	$151.22
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: Wellpoint Medicaid Managed Care	$17.04

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4511714
Hospital Revenue Code	914
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4822714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4527714
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	$151.22
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: Wellpoint Medicaid Managed Care	$17.04

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,450.00

Service Code	HCPCS 99205
Hospital Charge Code	421599205
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4546714
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

NEW PATIENT LEV 5 >=60 MINS

Facility

$1,450.00

Service Code	HCPCS 99205
Hospital Charge Code	485099205
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

Know your out-of-pocket cost for care.

All Charges