Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RW IM INJECTION

Facility

$149.00

Service Code	HCPCS 96372
Hospital Charge Code	87502840
Hospital Revenue Code	940
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

RW IND PSY 45-50 MINS W/MD

Facility

$550.00

Service Code	HCPCS 90836
Hospital Charge Code	87502915
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

RW IND PSY 45-50 MINS W/MD

Facility

$550.00

Service Code	HCPCS 90836
Hospital Charge Code	87502915
Hospital Revenue Code	914
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

RW IND PSYCHOTHER 20-30 MINS

Facility

$1,296.00

Service Code	HCPCS 90804
Hospital Charge Code	87502015
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

RW IND PSYCHOTHER 20-30 MINS

Facility

$1,296.00

Service Code	HCPCS 90804
Hospital Charge Code	87502015
Hospital Revenue Code	914
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$492.48
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
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: Wellpoint Medicaid Managed Care	$36.81

RW IND PSY THER 45-50 MINS

Facility

$425.00

Service Code	HCPCS 90834
Hospital Charge Code	87502910
Hospital Revenue Code	914
Min. Negotiated Rate	$12.07
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	$120.20
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	$110.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$13.43
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	$94.46
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

RW IND PSY THER 45-50 MINS

Facility

$425.00

Service Code	HCPCS 90834
Hospital Charge Code	87502910
Hospital Revenue Code	914
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

RW IND PSYTHERAPY INTACT 20-30

Facility

$275.00

Service Code	HCPCS 90832
Hospital Charge Code	87502900
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

RW IND PSYTHERAPY INTACT 20-30

Facility

$275.00

Service Code	HCPCS 90832
Hospital Charge Code	87502900
Hospital Revenue Code	914
Min. Negotiated Rate	$7.81
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	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$8.69
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	$7.81

RW IND PSY THER INT 20-30 W/MD

Facility

$350.00

Service Code	HCPCS 90833
Hospital Charge Code	87502905
Hospital Revenue Code	914
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

RW IND PSY THER INT 20-30 W/MD

Facility

$350.00

Service Code	HCPCS 90833
Hospital Charge Code	87502905
Hospital Revenue Code	914
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

RW IND PSYTHER INTACT 20-30MIN

Facility

$399.00

Service Code	HCPCS 90810
Hospital Charge Code	87502025
Hospital Revenue Code	914
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$199.50
Rate for Payer: Aetna Commercial	$151.62
Rate for Payer: Aetna Medicare Advantage	$119.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.75
Rate for Payer: Cigna Commercial	$199.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.74
Rate for Payer: Qualcare PPO/HMO/WC	$59.85
Rate for Payer: UnitedHealthcare Community & State	$12.61
Rate for Payer: Wellpoint Medicaid Managed Care	$11.33

RW IND PSYTHER INTACT 20-30MIN

Facility

$399.00

Service Code	HCPCS 90810
Hospital Charge Code	87502025
Hospital Revenue Code	914
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$59.85
Rate for Payer: Qualcare PPO/HMO/WC	$59.85

RW IND PSY THER INTACT 45-50

Facility

$536.00

Service Code	HCPCS 90812
Hospital Charge Code	87502030
Hospital Revenue Code	914
Min. Negotiated Rate	$15.22
Max. Negotiated Rate	$268.00
Rate for Payer: Aetna Commercial	$203.68
Rate for Payer: Aetna Medicare Advantage	$160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.68
Rate for Payer: Cigna Commercial	$268.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.36
Rate for Payer: Qualcare PPO/HMO/WC	$80.40
Rate for Payer: UnitedHealthcare Community & State	$16.94
Rate for Payer: Wellpoint Medicaid Managed Care	$15.22

RW IND PSY THER INTACT 45-50

Facility

$536.00

Service Code	HCPCS 90812
Hospital Charge Code	87502030
Hospital Revenue Code	914
Min. Negotiated Rate	$80.40
Max. Negotiated Rate	$80.40
Rate for Payer: Qualcare PPO/HMO/WC	$80.40

RW INDV PSYCHTHERPY 20-30 MTS

Facility

$23.00

Service Code	HCPCS 90804
Hospital Charge Code	84206230
Hospital Revenue Code	914
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

RW INDV PSYCHTHERPY 20-30 MTS

Facility

$23.00

Service Code	HCPCS 90804
Hospital Charge Code	84206230
Hospital Revenue Code	914
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

RW INDV PSYCHTHRPY 45-50 MTS

Facility

$1,423.80

Service Code	HCPCS 90806
Hospital Charge Code	84206235
Hospital Revenue Code	914
Min. Negotiated Rate	$40.44
Max. Negotiated Rate	$711.90
Rate for Payer: Aetna Commercial	$541.04
Rate for Payer: Aetna Medicare Advantage	$427.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.07
Rate for Payer: Cigna Commercial	$711.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.19
Rate for Payer: Qualcare PPO/HMO/WC	$213.57
Rate for Payer: UnitedHealthcare Community & State	$44.99
Rate for Payer: Wellpoint Medicaid Managed Care	$40.44

RW INDV PSYCHTHRPY 45-50 MTS

Facility

$1,423.80

Service Code	HCPCS 90806
Hospital Charge Code	84206235
Hospital Revenue Code	914
Min. Negotiated Rate	$213.57
Max. Negotiated Rate	$213.57
Rate for Payer: Qualcare PPO/HMO/WC	$213.57

RW INDV PSYCHTRPY INTACT 20-30

Facility

$21.00

Service Code	HCPCS 90810
Hospital Charge Code	84206240
Hospital Revenue Code	914
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

RW INDV PSYCHTRPY INTACT 20-30

Facility

$21.00

Service Code	HCPCS 90810
Hospital Charge Code	84206240
Hospital Revenue Code	914
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.46
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

RW INDV PSYTHRPY INTACT 45-50

Facility

$536.00

Service Code	HCPCS 90812
Hospital Charge Code	84206245
Hospital Revenue Code	914
Min. Negotiated Rate	$15.22
Max. Negotiated Rate	$268.00
Rate for Payer: Aetna Commercial	$203.68
Rate for Payer: Aetna Medicare Advantage	$160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.68
Rate for Payer: Cigna Commercial	$268.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.36
Rate for Payer: Qualcare PPO/HMO/WC	$80.40
Rate for Payer: UnitedHealthcare Community & State	$16.94
Rate for Payer: Wellpoint Medicaid Managed Care	$15.22

RW INDV PSYTHRPY INTACT 45-50

Facility

$536.00

Service Code	HCPCS 90812
Hospital Charge Code	84206245
Hospital Revenue Code	914
Min. Negotiated Rate	$80.40
Max. Negotiated Rate	$80.40
Rate for Payer: Qualcare PPO/HMO/WC	$80.40

RW INFANRIX VACCINE DTAP VIAL

Facility

$70.00

Service Code	HCPCS 90700
Hospital Charge Code	84206195
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$26.60
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.85
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

RW INFANRIX VACCINE DTAP VIAL

Facility

$70.00

Service Code	HCPCS 90700
Hospital Charge Code	84206195
Hospital Revenue Code	636
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$16.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

Know your out-of-pocket cost for care.

All Charges