Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TCM EXCISION BENIGN <1-2 CM

Facility

$1,049.00

Service Code	HCPCS 11402
Hospital Charge Code	93950017
Hospital Revenue Code	761
Min. Negotiated Rate	$29.79
Max. Negotiated Rate	$3,051.74
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.74
Rate for Payer: Oxford Commercial	$209.80
Rate for Payer: Qualcare PPO/HMO/WC	$157.35
Rate for Payer: UnitedHealthcare Commercial	$209.80
Rate for Payer: UnitedHealthcare Community & State	$33.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$29.79

TCM EXCISION BENIGN 2-3 CM

Facility

$1,049.00

Service Code	HCPCS 11403
Hospital Charge Code	93950019
Hospital Revenue Code	761
Min. Negotiated Rate	$157.35
Max. Negotiated Rate	$157.35
Rate for Payer: Qualcare PPO/HMO/WC	$157.35

TCM EXCISION BENIGN 2-3 CM

Facility

$1,049.00

Service Code	HCPCS 11403
Hospital Charge Code	93950019
Hospital Revenue Code	761
Min. Negotiated Rate	$29.79
Max. Negotiated Rate	$3,051.74
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.74
Rate for Payer: Oxford Commercial	$209.80
Rate for Payer: Qualcare PPO/HMO/WC	$157.35
Rate for Payer: UnitedHealthcare Commercial	$209.80
Rate for Payer: UnitedHealthcare Community & State	$33.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$29.79

TCM EXCISION/PUNCH BX

Facility

$678.00

Service Code	HCPCS 11400
Hospital Charge Code	93950013
Hospital Revenue Code	761
Min. Negotiated Rate	$101.70
Max. Negotiated Rate	$101.70
Rate for Payer: Qualcare PPO/HMO/WC	$101.70

TCM EXCISION/PUNCH BX

Facility

$678.00

Service Code	HCPCS 11400
Hospital Charge Code	93950013
Hospital Revenue Code	761
Min. Negotiated Rate	$19.26
Max. Negotiated Rate	$3,051.74
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.28
Rate for Payer: Oxford Commercial	$135.60
Rate for Payer: Qualcare PPO/HMO/WC	$101.70
Rate for Payer: UnitedHealthcare Commercial	$135.60
Rate for Payer: UnitedHealthcare Community & State	$21.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$19.26

TCM GLUCOMETER

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	93950055
Hospital Revenue Code	301
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.71
Rate for Payer: Aetna Medicare Advantage	$16.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.28
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.04
Rate for Payer: Clover Medicare Advantage	$4.79
Rate for Payer: EmblemHealth Commercial	$15.12
Rate for Payer: Humana Medicare Advantage	$5.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04
Rate for Payer: Wellcare Medicare Advantage	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TCM GLUCOMETER

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	93950055
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TCM HEPATITUS B (ADULTS)

Facility

$128.00

Service Code	HCPCS 90746
Hospital Charge Code	93950111
Hospital Revenue Code	636
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
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	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.64

TCM HEPATITUS B (ADULTS)

Facility

$128.00

Service Code	HCPCS 90746
Hospital Charge Code	93950111
Hospital Revenue Code	636
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TCM HIGH MDM F2F 7D

Facility

$764.00

Service Code	HCPCS 99496
Hospital Charge Code	412399496
Hospital Revenue Code	510
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$958.00
Rate for Payer: Aetna Commercial	$430.22
Rate for Payer: Aetna Medicare Advantage	$512.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.76
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: Cigna Medicare Advantage	$158.17
Rate for Payer: Clover Medicare Advantage	$150.26
Rate for Payer: EmblemHealth Commercial	$474.51
Rate for Payer: Humana Medicare Advantage	$162.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.64
Rate for Payer: Qualcare PPO/HMO/WC	$114.60
Rate for Payer: UnitedHealthcare Community & State	$24.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.17
Rate for Payer: Wellcare Medicare Advantage	$158.17
Rate for Payer: Wellpoint Medicaid Managed Care	$21.70

TCM HIGH MDM F2F 7D

Facility

$764.00

Service Code	HCPCS 99496
Hospital Charge Code	412399496
Hospital Revenue Code	510
Min. Negotiated Rate	$114.60
Max. Negotiated Rate	$1,197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,197.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.60

TCM HOS OBS STAT ADM DC SM DY

Facility

$203.00

Service Code	HCPCS 99235
Hospital Charge Code	93950165
Hospital Revenue Code	510
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$101.50
Rate for Payer: Aetna Commercial	$77.14
Rate for Payer: Aetna Medicare Advantage	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.77
Rate for Payer: Cigna Commercial	$101.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.78
Rate for Payer: Qualcare PPO/HMO/WC	$30.45
Rate for Payer: UnitedHealthcare Community & State	$6.41
Rate for Payer: Wellpoint Medicaid Managed Care	$5.77

TCM HOS OBS STAT ADM DC SM DY

Facility

$203.00

Service Code	HCPCS 99235
Hospital Charge Code	93950165
Hospital Revenue Code	510
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM INIT HOSPITAL ADMISSION 1

Facility

$145.00

Service Code	HCPCS 99221
Hospital Charge Code	93950153
Hospital Revenue Code	510
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.70
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: Wellpoint Medicaid Managed Care	$4.12

TCM INIT HOSPITAL ADMISSION 1

Facility

$145.00

Service Code	HCPCS 99221
Hospital Charge Code	93950153
Hospital Revenue Code	510
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

TCM INIT HOSPITAL ADMISSION 2

Facility

$203.00

Service Code	HCPCS 99222
Hospital Charge Code	93950155
Hospital Revenue Code	510
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM INIT HOSPITAL ADMISSION 2

Facility

$203.00

Service Code	HCPCS 99222
Hospital Charge Code	93950155
Hospital Revenue Code	510
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$101.50
Rate for Payer: Aetna Commercial	$77.14
Rate for Payer: Aetna Medicare Advantage	$60.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.77
Rate for Payer: Cigna Commercial	$101.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.78
Rate for Payer: Qualcare PPO/HMO/WC	$30.45
Rate for Payer: UnitedHealthcare Community & State	$6.41
Rate for Payer: Wellpoint Medicaid Managed Care	$5.77

TCM INIT HOSPITAL ADMISSION 3

Facility

$275.00

Service Code	HCPCS 99223
Hospital Charge Code	93950157
Hospital Revenue Code	510
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

TCM INIT HOSPITAL ADMISSION 3

Facility

$275.00

Service Code	HCPCS 99223
Hospital Charge Code	93950157
Hospital Revenue Code	510
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
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: Wellpoint Medicaid Managed Care	$7.81

TCM INTRALSNL INJCTNS UP TO 7

Facility

$1,033.25

Service Code	HCPCS 11900
Hospital Charge Code	93950023
Hospital Revenue Code	761
Min. Negotiated Rate	$154.99
Max. Negotiated Rate	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$154.99

TCM INTRALSNL INJCTNS UP TO 7

Facility

$1,033.25

Service Code	HCPCS 11900
Hospital Charge Code	93950023
Hospital Revenue Code	761
Min. Negotiated Rate	$22.11
Max. Negotiated Rate	$864.65
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.64
Rate for Payer: Oxford Commercial	$206.65
Rate for Payer: Qualcare PPO/HMO/WC	$154.99
Rate for Payer: UnitedHealthcare Commercial	$206.65
Rate for Payer: UnitedHealthcare Community & State	$32.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$29.34

TCM JOINT/BURSA TP AND/OR INJ

Facility

$440.00

Service Code	HCPCS 20610
Hospital Charge Code	93950037
Hospital Revenue Code	761
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

TCM JOINT/BURSA TP AND/OR INJ

Facility

$440.00

Service Code	HCPCS 20610
Hospital Charge Code	93950037
Hospital Revenue Code	761
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$1,322.84
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.40
Rate for Payer: Oxford Commercial	$88.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.00
Rate for Payer: UnitedHealthcare Commercial	$88.00
Rate for Payer: UnitedHealthcare Community & State	$13.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$12.50

TCM MOD MED COMPLEX

Facility

$645.75

Service Code	HCPCS 99495
Hospital Charge Code	412399495
Hospital Revenue Code	510
Min. Negotiated Rate	$96.86
Max. Negotiated Rate	$1,197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,197.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.86

TCM MOD MED COMPLEX

Facility

$645.75

Service Code	HCPCS 99495
Hospital Charge Code	412399495
Hospital Revenue Code	510
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$958.00
Rate for Payer: Aetna Commercial	$430.22
Rate for Payer: Aetna Medicare Advantage	$512.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.76
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: Cigna Medicare Advantage	$158.17
Rate for Payer: Clover Medicare Advantage	$150.26
Rate for Payer: EmblemHealth Commercial	$474.51
Rate for Payer: Humana Medicare Advantage	$162.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.86
Rate for Payer: UnitedHealthcare Community & State	$20.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.17
Rate for Payer: Wellcare Medicare Advantage	$158.17
Rate for Payer: Wellpoint Medicaid Managed Care	$18.34

Know your out-of-pocket cost for care.

All Charges