Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OFF VISIT EST PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84505030
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OFF VISIT EST PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84505030
Hospital Revenue Code	510
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.96
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$14.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

OFF VISIT EST PATIENT LEVEL3

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84505035
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OFF VISIT EST PATIENT LEVEL3

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84505035
Hospital Revenue Code	510
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna Commercial	$248.98
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.35
Rate for Payer: Qualcare PPO/HMO/WC	$98.28
Rate for Payer: UnitedHealthcare Community & State	$20.70
Rate for Payer: Wellpoint Medicaid Managed Care	$18.61

OFF VISIT EST PATIENT LEVEL 4

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84505040
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OFF VISIT EST PATIENT LEVEL 4

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84505040
Hospital Revenue Code	510
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.49
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$26.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.54

OFF VISIT EST PATIENT LEVEL 5

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84505045
Hospital Revenue Code	510
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.59
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$38.36
Rate for Payer: Wellpoint Medicaid Managed Care	$34.47

OFF VISIT EST PATIENT LEVEL 5

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84505045
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

OFF VISIT EST PATIENT LIVEL 1

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	84505025
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

OFF VISIT EST PATIENT LIVEL 1

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	84505025
Hospital Revenue Code	510
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$118.18
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.86
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

OFF VISIT NEW PATIENT LEVEL 1

Facility

$311.00

Service Code	HCPCS 99201
Hospital Charge Code	84505001
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

OFF VISIT NEW PATIENT LEVEL 1

Facility

$311.00

Service Code	HCPCS 99201
Hospital Charge Code	84505001
Hospital Revenue Code	510
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$118.18
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.86
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

OFF VISIT NEW PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84505005
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OFF VISIT NEW PATIENT LEVEL 2

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84505005
Hospital Revenue Code	510
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.96
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$14.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

OFF VISIT NEW PATIENT LEVEL 3

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84505010
Hospital Revenue Code	510
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.49
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$26.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.54

OFF VISIT NEW PATIENT LEVEL 3

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84505010
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OFF VISIT NEW PATIENT LEVEL 4

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84505015
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

OFF VISIT NEW PATIENT LEVEL 4

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84505015
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

OFF VISIT NEW PATIENT LEVEL 5

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	84505020
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

OFF VISIT NEW PATIENT LEVEL 5

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	84505020
Hospital Revenue Code	510
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$150.45
Rate for Payer: Qualcare PPO/HMO/WC	$150.45

OF HUMERUS FRACTURE

Facility

$63,943.60

Service Code	HCPCS 23615
Hospital Charge Code	16000816
Hospital Revenue Code	360
Min. Negotiated Rate	$9,591.54
Max. Negotiated Rate	$9,591.54
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54

OF HUMERUS FRACTURE

Facility

$63,943.60

Service Code	HCPCS 23615
Hospital Charge Code	16000816
Hospital Revenue Code	360
Min. Negotiated Rate	$1,816.00
Max. Negotiated Rate	$55,329.13
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55,329.13
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,625.34
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$2,020.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,816.00

OFLOXACIN 0.3% OTIC SOLN

Facility

$495.80

Service Code	NDC 61314001505
Hospital Charge Code	60629162
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$247.90
Rate for Payer: Aetna Commercial	$188.40
Rate for Payer: Aetna Medicare Advantage	$148.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.43
Rate for Payer: Cigna Commercial	$247.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.91
Rate for Payer: Oxford Commercial	$99.16
Rate for Payer: Qualcare PPO/HMO/WC	$74.37
Rate for Payer: UnitedHealthcare Commercial	$99.16
Rate for Payer: UnitedHealthcare Community & State	$15.67
Rate for Payer: Wellpoint Medicaid Managed Care	$14.08

OFLOXACIN 0.3% OTIC SOLN

Facility

$495.80

Service Code	NDC 61314001505
Hospital Charge Code	60629162
Hospital Revenue Code	250
Min. Negotiated Rate	$74.37
Max. Negotiated Rate	$74.37
Rate for Payer: Qualcare PPO/HMO/WC	$74.37

OFLOXACIN .3% EYEDROP 5ML

Facility

$140.30

Service Code	NDC 17478071310
Hospital Charge Code	60635790
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$70.15
Rate for Payer: Aetna Commercial	$53.31
Rate for Payer: Aetna Medicare Advantage	$42.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.78
Rate for Payer: Cigna Commercial	$70.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.48
Rate for Payer: Oxford Commercial	$28.06
Rate for Payer: Qualcare PPO/HMO/WC	$21.05
Rate for Payer: UnitedHealthcare Commercial	$28.06
Rate for Payer: UnitedHealthcare Community & State	$4.43
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

Know your out-of-pocket cost for care.

All Charges