Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TCM PREVNTVE EST PT 12-17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	93950193
Hospital Revenue Code	510
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

TCM PREVNTVE EST PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99395
Hospital Charge Code	93950195
Hospital Revenue Code	510
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

TCM PREVNTVE EST PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99395
Hospital Charge Code	93950195
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE EST PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99396
Hospital Charge Code	93950197
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE EST PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99396
Hospital Charge Code	93950197
Hospital Revenue Code	510
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

TCM PREVNTVE NEW PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99385
Hospital Charge Code	93950181
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVNTVE NEW PT 18-39 YRS

Facility

$175.00

Service Code	HCPCS 99385
Hospital Charge Code	93950181
Hospital Revenue Code	510
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

TCM PREVNTVE NEW PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99386
Hospital Charge Code	93950183
Hospital Revenue Code	510
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

TCM PREVNTVE NEW PT 40-64 YRS

Facility

$175.00

Service Code	HCPCS 99386
Hospital Charge Code	93950183
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM REMOVE SKIN TAG ECH AD 10

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	93950011
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

TCM REMOVE SKIN TAG ECH AD 10

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	93950011
Hospital Revenue Code	761
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$141.36
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.72
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$11.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.56

TCM REMOVE SKIN TAG FIRST 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	93950009
Hospital Revenue Code	761
Min. Negotiated Rate	$10.56
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	$32.67
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	$96.72
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$11.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$10.56

TCM REMOVE SKIN TAG FIRST 15

Facility

$372.00

Service Code	HCPCS 11200
Hospital Charge Code	93950009
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

TCM SUBSEQ HOSP VISIT LEVEL 1

Facility

$145.00

Service Code	HCPCS 99231
Hospital Charge Code	93950159
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 SUBSEQ HOSP VISIT LEVEL 1

Facility

$145.00

Service Code	HCPCS 99231
Hospital Charge Code	93950159
Hospital Revenue Code	510
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

TCM SUBSEQ HOSP VISIT LEVEL 2

Facility

$174.00

Service Code	HCPCS 99232
Hospital Charge Code	93950161
Hospital Revenue Code	510
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

TCM SUBSEQ HOSP VISIT LEVEL 2

Facility

$174.00

Service Code	HCPCS 99232
Hospital Charge Code	93950161
Hospital Revenue Code	510
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.24
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.94

TCM SUBSEQ HOSP VISIT LEVEL 3

Facility

$203.00

Service Code	HCPCS 99233
Hospital Charge Code	93950163
Hospital Revenue Code	510
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

TCM SUBSEQ HOSP VISIT LEVEL 3

Facility

$203.00

Service Code	HCPCS 99233
Hospital Charge Code	93950163
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

TCU ADL TRAINING EA 15 MINUTES

Facility

$142.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008320
Hospital Revenue Code	430
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

TCU ADL TRAINING EA 15 MINUTES

Facility

$142.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008320
Hospital Revenue Code	430
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$53.96
Rate for Payer: Aetna Medicare Advantage	$42.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.21
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.92
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.49
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

TCU DYNAMIC EXTENSION SPLINT

Facility

$106.00

Hospital Charge Code	1008395
Hospital Revenue Code	270
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

TCU DYNAMIC EXTENSION SPLINT

Facility

$106.00

Hospital Charge Code	1008395
Hospital Revenue Code	270
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.56
Rate for Payer: Oxford Commercial	$21.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$21.20
Rate for Payer: UnitedHealthcare Community & State	$3.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

TCU ELASTICIZED BANDAGE

Facility

$40.00

Hospital Charge Code	1008385
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

TCU ELASTICIZED BANDAGE

Facility

$40.00

Hospital Charge Code	1008385
Hospital Revenue Code	270
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

Know your out-of-pocket cost for care.

All Charges