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	4824714
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	485599205
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

NEW PATIENT LEV 5 >=60 MINS

Facility

$600.00

Service Code	HCPCS 99205
Hospital Charge Code	4517714
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	485599205
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	4502714
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	$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	4517714
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	4824714
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	9800320
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

NEW PATIENT REFERRED COMPLEX

Facility

$867.00

Service Code	HCPCS 99245
Hospital Charge Code	84505060
Hospital Revenue Code	510
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$130.05
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

NEW PATIENT REFERRED COMPLEX

Facility

$867.00

Service Code	HCPCS 99245
Hospital Charge Code	84505060
Hospital Revenue Code	510
Min. Negotiated Rate	$24.62
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna Medicare Advantage	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.09
Rate for Payer: Cigna Commercial	$433.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.42
Rate for Payer: Qualcare PPO/HMO/WC	$130.05
Rate for Payer: UnitedHealthcare Community & State	$27.40
Rate for Payer: Wellpoint Medicaid Managed Care	$24.62

NEW PATIENT REFERRED-EXTENSIVE

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	84505055
Hospital Revenue Code	510
Min. Negotiated Rate	$174.09
Max. Negotiated Rate	$174.09
Rate for Payer: Qualcare PPO/HMO/WC	$174.09

NEW PATIENT REFERRED-EXTENSIVE

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	84505055
Hospital Revenue Code	510
Min. Negotiated Rate	$32.96
Max. Negotiated Rate	$580.30
Rate for Payer: Aetna Commercial	$441.03
Rate for Payer: Aetna Medicare Advantage	$348.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.95
Rate for Payer: Cigna Commercial	$580.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.76
Rate for Payer: Qualcare PPO/HMO/WC	$174.09
Rate for Payer: UnitedHealthcare Community & State	$36.67
Rate for Payer: Wellpoint Medicaid Managed Care	$32.96

NEW PATIENT REFERRED - LIMITED

Facility

$405.00

Service Code	HCPCS 99242
Hospital Charge Code	84505050
Hospital Revenue Code	510
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

NEW PATIENT REFERRED - LIMITED

Facility

$405.00

Service Code	HCPCS 99242
Hospital Charge Code	84505050
Hospital Revenue Code	510
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Community & State	$12.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

NEXGEN ALL-POLY PATELLA, 29MM

Facility

$13,075.00

Hospital Charge Code	270657043
Hospital Revenue Code	278
Min. Negotiated Rate	$1,961.25
Max. Negotiated Rate	$3,164.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,164.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.25

NEXGEN ALL-POLY PATELLA, 29MM

Facility

$13,075.00

Hospital Charge Code	270657043
Hospital Revenue Code	278
Min. Negotiated Rate	$371.33
Max. Negotiated Rate	$6,537.50
Rate for Payer: Aetna Commercial	$4,968.50
Rate for Payer: Aetna Medicare Advantage	$3,922.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,334.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,334.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,334.12
Rate for Payer: Cigna Commercial	$6,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,164.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,961.25
Rate for Payer: UnitedHealthcare Community & State	$413.17
Rate for Payer: Wellpoint Medicaid Managed Care	$371.33

NEXGEN ALL-POLY PATELLA,32MM

Facility

$2,297.75

Hospital Charge Code	270662346
Hospital Revenue Code	278
Min. Negotiated Rate	$65.26
Max. Negotiated Rate	$1,148.88
Rate for Payer: Aetna Commercial	$873.14
Rate for Payer: Aetna Medicare Advantage	$689.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$585.93
Rate for Payer: Cigna Commercial	$1,148.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: Qualcare PPO/HMO/WC	$344.66
Rate for Payer: UnitedHealthcare Community & State	$72.61
Rate for Payer: Wellpoint Medicaid Managed Care	$65.26

NEXGEN ALL-POLY PATELLA,32MM

Facility

$2,297.75

Hospital Charge Code	270662346
Hospital Revenue Code	278
Min. Negotiated Rate	$344.66
Max. Negotiated Rate	$556.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: Qualcare PPO/HMO/WC	$344.66

NEXGEN ALLY-POLY PATELLA

Facility

$2,620.00

Hospital Charge Code	270658854
Hospital Revenue Code	278
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$634.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$634.04
Rate for Payer: Qualcare PPO/HMO/WC	$393.00

NEXGEN ALLY-POLY PATELLA

Facility

$2,620.00

Hospital Charge Code	270658854
Hospital Revenue Code	278
Min. Negotiated Rate	$74.41
Max. Negotiated Rate	$1,310.00
Rate for Payer: Aetna Commercial	$995.60
Rate for Payer: Aetna Medicare Advantage	$786.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$668.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$668.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$668.10
Rate for Payer: Cigna Commercial	$1,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$634.04
Rate for Payer: Qualcare PPO/HMO/WC	$393.00
Rate for Payer: UnitedHealthcare Community & State	$82.79
Rate for Payer: Wellpoint Medicaid Managed Care	$74.41

NEXGEN AUG PATELLA MED THICK

Facility

$16,980.00

Service Code	HCPCS C1776
Hospital Charge Code	270683821
Hospital Revenue Code	278
Min. Negotiated Rate	$482.23
Max. Negotiated Rate	$8,490.00
Rate for Payer: Aetna Commercial	$6,452.40
Rate for Payer: Aetna Medicare Advantage	$5,094.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,329.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,329.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,396.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,329.90
Rate for Payer: Cigna Commercial	$8,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,109.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,547.00
Rate for Payer: UnitedHealthcare Community & State	$536.57
Rate for Payer: Wellpoint Medicaid Managed Care	$482.23

NEXGEN AUG PATELLA MED THICK

Facility

$16,980.00

Service Code	HCPCS C1776
Hospital Charge Code	270683821
Hospital Revenue Code	278
Min. Negotiated Rate	$2,547.00
Max. Negotiated Rate	$4,109.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,396.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,109.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,547.00

NEXGEN KNEE REPLACEMENT,

Facility

$2,640.00

Service Code	HCPCS C1776
Hospital Charge Code	270657860
Hospital Revenue Code	278
Min. Negotiated Rate	$74.98
Max. Negotiated Rate	$1,320.00
Rate for Payer: Aetna Commercial	$1,003.20
Rate for Payer: Aetna Medicare Advantage	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$673.20
Rate for Payer: Cigna Commercial	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: Qualcare PPO/HMO/WC	$396.00
Rate for Payer: UnitedHealthcare Community & State	$83.42
Rate for Payer: Wellpoint Medicaid Managed Care	$74.98

NEXGEN KNEE REPLACEMENT,

Facility

$2,640.00

Service Code	HCPCS C1776
Hospital Charge Code	270657860
Hospital Revenue Code	278
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$638.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: Qualcare PPO/HMO/WC	$396.00

Know your out-of-pocket cost for care.

All Charges