Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WC LC SKIN SUB HD/FT/DG 1ST25C

Facility

$2,431.36

Service Code	HCPCS C5275
Hospital Charge Code	9808305
Hospital Revenue Code	510
Min. Negotiated Rate	$69.05
Max. Negotiated Rate	$1,215.68
Rate for Payer: Aetna Commercial	$923.92
Rate for Payer: Aetna Medicare Advantage	$729.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$620.00
Rate for Payer: Cigna Commercial	$1,215.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.15
Rate for Payer: Qualcare PPO/HMO/WC	$364.70
Rate for Payer: UnitedHealthcare Community & State	$76.83
Rate for Payer: Wellpoint Medicaid Managed Care	$69.05

WC LC SKIN SUB HD/FT/DG 1ST25C

Facility

$2,431.36

Service Code	HCPCS C5275
Hospital Charge Code	9808305
Hospital Revenue Code	510
Min. Negotiated Rate	$364.70
Max. Negotiated Rate	$364.70
Rate for Payer: Qualcare PPO/HMO/WC	$364.70

WC LC SKIN SUB HD/FT/DG ADD100

Facility

$1,183.95

Service Code	HCPCS C5278
Hospital Charge Code	9808320
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC LC SKIN SUB HD/FT/DG ADD100

Facility

$1,183.95

Service Code	HCPCS C5278
Hospital Charge Code	9808320
Hospital Revenue Code	510
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$449.90
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.83
Rate for Payer: Qualcare PPO/HMO/WC	$177.59
Rate for Payer: UnitedHealthcare Community & State	$37.41
Rate for Payer: Wellpoint Medicaid Managed Care	$33.62

WC LC SKIN SUB HD/FT/DG ADD25C

Facility

$1,183.95

Service Code	HCPCS C5276
Hospital Charge Code	9808310
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC LC SKIN SUB HD/FT/DG ADD25C

Facility

$1,183.95

Service Code	HCPCS C5276
Hospital Charge Code	9808310
Hospital Revenue Code	510
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$449.90
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.83
Rate for Payer: Qualcare PPO/HMO/WC	$177.59
Rate for Payer: UnitedHealthcare Community & State	$37.41
Rate for Payer: Wellpoint Medicaid Managed Care	$33.62

WC LC SKIN SUB TR/AR/L 1ST100C

Facility

$8,143.08

Service Code	HCPCS C5273
Hospital Charge Code	9808295
Hospital Revenue Code	510
Min. Negotiated Rate	$231.26
Max. Negotiated Rate	$4,071.54
Rate for Payer: Aetna Commercial	$3,094.37
Rate for Payer: Aetna Medicare Advantage	$2,442.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,076.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,076.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,076.49
Rate for Payer: Cigna Commercial	$4,071.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,221.46
Rate for Payer: UnitedHealthcare Community & State	$257.32
Rate for Payer: Wellpoint Medicaid Managed Care	$231.26

WC LC SKIN SUB TR/AR/L 1ST100C

Facility

$8,143.08

Service Code	HCPCS C5273
Hospital Charge Code	9808295
Hospital Revenue Code	510
Min. Negotiated Rate	$1,221.46
Max. Negotiated Rate	$1,221.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,221.46

WC LC SKIN SUB TR/AR/L 1ST25CM

Facility

$2,431.36

Service Code	HCPCS C5271
Hospital Charge Code	9808285
Hospital Revenue Code	510
Min. Negotiated Rate	$364.70
Max. Negotiated Rate	$364.70
Rate for Payer: Qualcare PPO/HMO/WC	$364.70

WC LC SKIN SUB TR/AR/L 1ST25CM

Facility

$2,431.36

Service Code	HCPCS C5271
Hospital Charge Code	9808285
Hospital Revenue Code	510
Min. Negotiated Rate	$69.05
Max. Negotiated Rate	$1,215.68
Rate for Payer: Aetna Commercial	$923.92
Rate for Payer: Aetna Medicare Advantage	$729.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$620.00
Rate for Payer: Cigna Commercial	$1,215.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.15
Rate for Payer: Qualcare PPO/HMO/WC	$364.70
Rate for Payer: UnitedHealthcare Community & State	$76.83
Rate for Payer: Wellpoint Medicaid Managed Care	$69.05

WC LC SKIN SUB TR/AR/L ADD100C

Facility

$1,183.95

Service Code	HCPCS C5274
Hospital Charge Code	9808300
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC LC SKIN SUB TR/AR/L ADD100C

Facility

$1,183.95

Service Code	HCPCS C5274
Hospital Charge Code	9808300
Hospital Revenue Code	510
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$449.90
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.83
Rate for Payer: Qualcare PPO/HMO/WC	$177.59
Rate for Payer: UnitedHealthcare Community & State	$37.41
Rate for Payer: Wellpoint Medicaid Managed Care	$33.62

WC LC SKIN SUB TR/AR/L ADD25CM

Facility

$1,183.95

Service Code	HCPCS C5272
Hospital Charge Code	9808290
Hospital Revenue Code	510
Min. Negotiated Rate	$177.59
Max. Negotiated Rate	$177.59
Rate for Payer: Qualcare PPO/HMO/WC	$177.59

WC LC SKIN SUB TR/AR/L ADD25CM

Facility

$1,183.95

Service Code	HCPCS C5272
Hospital Charge Code	9808290
Hospital Revenue Code	510
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$591.98
Rate for Payer: Aetna Commercial	$449.90
Rate for Payer: Aetna Medicare Advantage	$355.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.91
Rate for Payer: Cigna Commercial	$591.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.83
Rate for Payer: Qualcare PPO/HMO/WC	$177.59
Rate for Payer: UnitedHealthcare Community & State	$37.41
Rate for Payer: Wellpoint Medicaid Managed Care	$33.62

WC LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	9800355
Hospital Revenue Code	510
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$118.18
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.86
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

WC LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	9800355
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

WC LEVEL 1 FOLLOWUP VIST+MOD25

Facility

$311.00

Service Code	HCPCS 9921125
Hospital Charge Code	9800360
Hospital Revenue Code	510
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.50
Rate for Payer: Aetna Commercial	$118.18
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$155.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.86
Rate for Payer: Qualcare PPO/HMO/WC	$46.65
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

WC LEVEL 1 FOLLOWUP VIST+MOD25

Facility

$311.00

Service Code	HCPCS 9921125
Hospital Charge Code	9800360
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

WC LEVEL 1 I&D FB REMOVAL

Facility

$1,061.25

Service Code	HCPCS 10120
Hospital Charge Code	9800020
Hospital Revenue Code	510
Min. Negotiated Rate	$30.14
Max. Negotiated Rate	$1,751.90
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.93
Rate for Payer: Qualcare PPO/HMO/WC	$159.19
Rate for Payer: UnitedHealthcare Community & State	$33.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$30.14

WC LEVEL 1 I&D FB REMOVAL

Facility

$1,061.25

Service Code	HCPCS 10120
Hospital Charge Code	9800020
Hospital Revenue Code	510
Min. Negotiated Rate	$159.19
Max. Negotiated Rate	$159.19
Rate for Payer: Qualcare PPO/HMO/WC	$159.19

WC LEVEL 1 I&D PUNCTURE DRAIN

Facility

$1,687.00

Service Code	HCPCS 10160
Hospital Charge Code	9800015
Hospital Revenue Code	510
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$253.05
Rate for Payer: Qualcare PPO/HMO/WC	$253.05

WC LEVEL 1 I&D PUNCTURE DRAIN

Facility

$1,687.00

Service Code	HCPCS 10160
Hospital Charge Code	9800015
Hospital Revenue Code	510
Min. Negotiated Rate	$47.91
Max. Negotiated Rate	$1,751.90
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.62
Rate for Payer: Qualcare PPO/HMO/WC	$253.05
Rate for Payer: UnitedHealthcare Community & State	$53.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$47.91

WC LEVEL 1 I&D - SKIN ABCESS

Facility

$745.00

Service Code	HCPCS 10060
Hospital Charge Code	9800010
Hospital Revenue Code	510
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$962.01
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	$28.06
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	$193.70
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$962.01
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

WC LEVEL 1 I&D - SKIN ABCESS

Facility

$745.00

Service Code	HCPCS 10060
Hospital Charge Code	9800010
Hospital Revenue Code	510
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$111.75
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

WC LEVEL 1 INITIAL VISIT

Facility

$350.00

Service Code	HCPCS 99201
Hospital Charge Code	9800280
Hospital Revenue Code	510
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

Know your out-of-pocket cost for care.

All Charges