Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PSYCH EMERGENCY SCREENING

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84310190
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

PSYCH EMERGENCY SCREENING

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84310190
Hospital Revenue Code	914
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.96
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Community & State	$40.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71.39
Rate for Payer: Wellpoint Medicaid Managed Care	$36.81

PSYCH E&M LEVEL I 10 MINS

Facility

$433.40

Hospital Charge Code	84310140
Hospital Revenue Code	513
Min. Negotiated Rate	$65.01
Max. Negotiated Rate	$65.01
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

PSYCH E&M LEVEL I 10 MINS

Facility

$433.40

Hospital Charge Code	84310140
Hospital Revenue Code	513
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$216.70
Rate for Payer: Aetna Commercial	$164.69
Rate for Payer: Aetna Medicare Advantage	$130.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.52
Rate for Payer: Cigna Commercial	$216.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.68
Rate for Payer: Qualcare PPO/HMO/WC	$65.01
Rate for Payer: UnitedHealthcare Community & State	$13.70
Rate for Payer: Wellpoint Medicaid Managed Care	$12.31

PSYCH E&M LEVEL II 20MINS

Facility

$367.85

Hospital Charge Code	84310145
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

PSYCH E&M LEVEL II 20MINS

Facility

$367.85

Hospital Charge Code	84310145
Hospital Revenue Code	513
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.64
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$11.62
Rate for Payer: Wellpoint Medicaid Managed Care	$10.45

PSYCH E&M LEVEL III 30MINS

Facility

$484.05

Hospital Charge Code	84310150
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

PSYCH E&M LEVEL III 30MINS

Facility

$484.05

Hospital Charge Code	84310150
Hospital Revenue Code	513
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$242.03
Rate for Payer: Aetna Commercial	$183.94
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$242.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.85
Rate for Payer: Qualcare PPO/HMO/WC	$72.61
Rate for Payer: UnitedHealthcare Community & State	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$13.75

PSYCH E&M LEVEL IV 45 MINS

Facility

$641.45

Hospital Charge Code	84310155
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

PSYCH E&M LEVEL IV 45 MINS

Facility

$641.45

Hospital Charge Code	84310155
Hospital Revenue Code	513
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.78
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$20.27
Rate for Payer: Wellpoint Medicaid Managed Care	$18.22

PSYCH E&M LEVEL V 60 MINS

Facility

$877.65

Hospital Charge Code	84310160
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

PSYCH E&M LEVEL V 60 MINS

Facility

$877.65

Hospital Charge Code	84310160
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

PSYCH ER URINALYSIS,DIP STICK

Facility

$22.00

Service Code	HCPCS 81000
Hospital Charge Code	7508001
Hospital Revenue Code	307
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

PSYCH ER URINALYSIS,DIP STICK

Facility

$22.00

Service Code	HCPCS 81000
Hospital Charge Code	7508001
Hospital Revenue Code	307
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$10.93
Rate for Payer: Aetna Medicare Advantage	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.58
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: Cigna Medicare Advantage	$4.02
Rate for Payer: Clover Medicare Advantage	$3.82
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Humana Medicare Advantage	$4.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.72
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.02
Rate for Payer: Wellcare Medicare Advantage	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

PSYCHIATRIC DIAG EVAL NON MD

Facility

$550.00

Service Code	HCPCS 90791
Hospital Charge Code	84504005
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCHIATRIC DIAG EVAL NON MD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	87506080
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCHIATRIC DIAG EVAL NON MD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	87506080
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$246.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,768.00
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$214.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99
Rate for Payer: Wellpoint Medicaid Managed Care	$193.12

PSYCHIATRIC DIAG EVAL NON MD

Facility

$550.00

Service Code	HCPCS 90791
Hospital Charge Code	84504005
Hospital Revenue Code	900
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$246.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

PSYCHIATRIC DIAG EVAL W/MS

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	84511003
Hospital Revenue Code	900
Min. Negotiated Rate	$193.12
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$612.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,768.00
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$214.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76
Rate for Payer: Wellpoint Medicaid Managed Care	$193.12

PSYCHIATRIC DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84504010
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCHIATRIC DIAG EVAL W/MS

Facility

$1,296.00

Service Code	HCPCS 90792
Hospital Charge Code	87504010
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

PSYCHIATRIC DIAG EVAL W/MS

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	84511003
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCHIATRIC DIAG EVAL W/MS

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	84509003
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCHIATRIC DIAG EVAL W/MS

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	84509003
Hospital Revenue Code	900
Min. Negotiated Rate	$193.12
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$612.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,768.00
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$214.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76
Rate for Payer: Wellpoint Medicaid Managed Care	$193.12

PSYCHIATRIC DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84518003
Hospital Revenue Code	900
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$612.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

Know your out-of-pocket cost for care.

All Charges