Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RW ENDOMETRIAL BIOPSY

Facility

$669.00

Service Code	HCPCS 58100
Hospital Charge Code	84206115
Hospital Revenue Code	361
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

RW ENGERIX 20 MCG/1ML HEP B AD

Facility

$91.00

Service Code	HCPCS 90746
Hospital Charge Code	84206220
Hospital Revenue Code	636
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$59.40
Rate for Payer: Aetna Commercial	$34.58
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Community & State	$2.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

RW ENGERIX 20 MCG/1ML HEP B AD

Facility

$91.00

Service Code	HCPCS 90746
Hospital Charge Code	84206220
Hospital Revenue Code	636
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$22.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

RW EST. PT - VISIT - COMPREHEN

Facility

$88.00

Service Code	HCPCS 99215
Hospital Charge Code	84206355
Hospital Revenue Code	510
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: Wellpoint Medicaid Managed Care	$2.50

RW EST. PT - VISIT - COMPREHEN

Facility

$88.00

Service Code	HCPCS 99215
Hospital Charge Code	84206355
Hospital Revenue Code	510
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

RW EST. PT - VISIT - DETAILED

Facility

$282.80

Service Code	HCPCS 99214
Hospital Charge Code	84206405
Hospital Revenue Code	510
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$141.40
Rate for Payer: Aetna Commercial	$107.46
Rate for Payer: Aetna Medicare Advantage	$84.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.11
Rate for Payer: Cigna Commercial	$141.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.53
Rate for Payer: Qualcare PPO/HMO/WC	$42.42
Rate for Payer: UnitedHealthcare Community & State	$8.94
Rate for Payer: Wellpoint Medicaid Managed Care	$8.03

RW EST. PT - VISIT - DETAILED

Facility

$282.80

Service Code	HCPCS 99214
Hospital Charge Code	84206405
Hospital Revenue Code	510
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$42.42
Rate for Payer: Qualcare PPO/HMO/WC	$42.42

RW EST.PT-VISIT-DETAILED

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84206350
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

RW EST.PT-VISIT-DETAILED

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84206350
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

RW EST. PT - VISIT - EXPANDED

Facility

$51.00

Service Code	HCPCS 99213
Hospital Charge Code	84206345
Hospital Revenue Code	510
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

RW EST. PT - VISIT - EXPANDED

Facility

$51.00

Service Code	HCPCS 99213
Hospital Charge Code	84206345
Hospital Revenue Code	510
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.26
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

RW EST. PT - VISIT - FOCUSED

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	84206340
Hospital Revenue Code	510
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$118.00
Rate for Payer: Aetna Commercial	$89.68
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.36
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

RW EST. PT - VISIT - FOCUSED

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	84206340
Hospital Revenue Code	510
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

RW EST. PT - VISIT - MINIMAL

Facility

$114.00

Service Code	HCPCS 99211
Hospital Charge Code	84206335
Hospital Revenue Code	510
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$43.32
Rate for Payer: Aetna Medicare Advantage	$34.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.07
Rate for Payer: Cigna Commercial	$57.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.64
Rate for Payer: Qualcare PPO/HMO/WC	$17.10
Rate for Payer: UnitedHealthcare Community & State	$3.60
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

RW EST. PT - VISIT - MINIMAL

Facility

$114.00

Service Code	HCPCS 99211
Hospital Charge Code	84206335
Hospital Revenue Code	510
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$17.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.10

RW FB REMOVAL, EAR

Facility

$299.00

Service Code	HCPCS 69200
Hospital Charge Code	84206125
Hospital Revenue Code	761
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

RW FB REMOVAL, EAR

Facility

$299.00

Service Code	HCPCS 69200
Hospital Charge Code	84206125
Hospital Revenue Code	761
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$573.36
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.74
Rate for Payer: Oxford Commercial	$59.80
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$59.80
Rate for Payer: UnitedHealthcare Community & State	$9.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

RW FB REMOVAL-EAR

Facility

$299.00

Service Code	HCPCS 69200
Hospital Charge Code	87502095
Hospital Revenue Code	761
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$573.36
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.74
Rate for Payer: Oxford Commercial	$59.80
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$59.80
Rate for Payer: UnitedHealthcare Community & State	$9.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

RW FB REMOVAL-EAR

Facility

$299.00

Service Code	HCPCS 69200
Hospital Charge Code	87502095
Hospital Revenue Code	761
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

RW FB REMOVAL - EYE

Facility

$397.00

Service Code	HCPCS 65205
Hospital Charge Code	87502100
Hospital Revenue Code	361
Min. Negotiated Rate	$59.55
Max. Negotiated Rate	$59.55
Rate for Payer: Qualcare PPO/HMO/WC	$59.55

RW FB REMOVAL - EYE

Facility

$397.00

Service Code	HCPCS 65205
Hospital Charge Code	87502100
Hospital Revenue Code	361
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.22
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.55
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$12.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$11.27

RW FB REMOVAL,EYE

Facility

$397.00

Service Code	HCPCS 65205
Hospital Charge Code	84206120
Hospital Revenue Code	361
Min. Negotiated Rate	$59.55
Max. Negotiated Rate	$59.55
Rate for Payer: Qualcare PPO/HMO/WC	$59.55

RW FB REMOVAL,EYE

Facility

$397.00

Service Code	HCPCS 65205
Hospital Charge Code	84206120
Hospital Revenue Code	361
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.22
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.55
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$12.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$11.27

RW GARDISIL

Facility

$273.00

Service Code	HCPCS 90649
Hospital Charge Code	87502857
Hospital Revenue Code	636
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$66.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.07
Rate for Payer: Qualcare PPO/HMO/WC	$40.95

RW GARDISIL

Facility

$273.00

Service Code	HCPCS 90649
Hospital Charge Code	87502857
Hospital Revenue Code	636
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$139.96
Rate for Payer: Aetna Commercial	$103.74
Rate for Payer: Aetna Medicare Advantage	$81.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.61
Rate for Payer: Cigna Commercial	$136.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.07
Rate for Payer: Qualcare PPO/HMO/WC	$40.95
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.75

Know your out-of-pocket cost for care.

All Charges