Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WC LEVEL 1 INITIAL VISIT

Facility

$350.00

Service Code	HCPCS 99201
Hospital Charge Code	9800280
Hospital Revenue Code	510
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) 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: Wellpoint Medicaid Managed Care	$9.94

WC LEVEL 1 INITIAL VISIT+MOD25

Facility

$350.00

Service Code	HCPCS 9920125
Hospital Charge Code	9800285
Hospital Revenue Code	510
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

WC LEVEL 1 INITIAL VISIT+MOD25

Facility

$350.00

Service Code	HCPCS 9920125
Hospital Charge Code	9800285
Hospital Revenue Code	510
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) 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: Wellpoint Medicaid Managed Care	$9.94

WC LEVEL 1 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99241
Hospital Charge Code	9800330
Hospital Revenue Code	510
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$112.60
Rate for Payer: Aetna Commercial	$85.58
Rate for Payer: Aetna Medicare Advantage	$67.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.43
Rate for Payer: Cigna Commercial	$112.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.55
Rate for Payer: Qualcare PPO/HMO/WC	$33.78
Rate for Payer: UnitedHealthcare Community & State	$7.12
Rate for Payer: Wellpoint Medicaid Managed Care	$6.40

WC LEVEL 1 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99241
Hospital Charge Code	9800330
Hospital Revenue Code	510
Min. Negotiated Rate	$33.78
Max. Negotiated Rate	$33.78
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

WC LEVEL 2 FOLLOWUP VIST+MOD25

Facility

$446.00

Service Code	HCPCS 9921225
Hospital Charge Code	9800370
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

WC LEVEL 2 FOLLOWUP VIST+MOD25

Facility

$446.00

Service Code	HCPCS 9921225
Hospital Charge Code	9800370
Hospital Revenue Code	510
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.96
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$14.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

WC LEVEL 2 I&D HEMATOMA

Facility

$5,321.00

Service Code	HCPCS 10140
Hospital Charge Code	9800025
Hospital Revenue Code	510
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,383.46
Rate for Payer: Qualcare PPO/HMO/WC	$798.15
Rate for Payer: UnitedHealthcare Community & State	$168.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$151.12

WC LEVEL 2 I&D HEMATOMA

Facility

$5,321.00

Service Code	HCPCS 10140
Hospital Charge Code	9800025
Hospital Revenue Code	510
Min. Negotiated Rate	$798.15
Max. Negotiated Rate	$798.15
Rate for Payer: Qualcare PPO/HMO/WC	$798.15

WC LEVEL 2 INITIAL VISIT+MOD25

Facility

$474.10

Service Code	HCPCS 9920225
Hospital Charge Code	9800295
Hospital Revenue Code	510
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$237.05
Rate for Payer: Aetna Commercial	$180.16
Rate for Payer: Aetna Medicare Advantage	$142.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.90
Rate for Payer: Cigna Commercial	$237.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.27
Rate for Payer: Qualcare PPO/HMO/WC	$71.11
Rate for Payer: UnitedHealthcare Community & State	$14.98
Rate for Payer: Wellpoint Medicaid Managed Care	$13.46

WC LEVEL 2 INITIAL VISIT+MOD25

Facility

$474.10

Service Code	HCPCS 9920225
Hospital Charge Code	9800295
Hospital Revenue Code	510
Min. Negotiated Rate	$71.11
Max. Negotiated Rate	$71.11
Rate for Payer: Qualcare PPO/HMO/WC	$71.11

WC LEVEL 2 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99242
Hospital Charge Code	9800335
Hospital Revenue Code	510
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$112.60
Rate for Payer: Aetna Commercial	$85.58
Rate for Payer: Aetna Medicare Advantage	$67.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.43
Rate for Payer: Cigna Commercial	$112.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.55
Rate for Payer: Qualcare PPO/HMO/WC	$33.78
Rate for Payer: UnitedHealthcare Community & State	$7.12
Rate for Payer: Wellpoint Medicaid Managed Care	$6.40

WC LEVEL 2 OUTPATIENT CONSULT

Facility

$225.20

Service Code	HCPCS 99242
Hospital Charge Code	9800335
Hospital Revenue Code	510
Min. Negotiated Rate	$33.78
Max. Negotiated Rate	$33.78
Rate for Payer: Qualcare PPO/HMO/WC	$33.78

WC LEVEL 3 FOLLOWUP VIST+MOD25

Facility

$655.20

Service Code	HCPCS 9921325
Hospital Charge Code	9800380
Hospital Revenue Code	510
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna Commercial	$248.98
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.35
Rate for Payer: Qualcare PPO/HMO/WC	$98.28
Rate for Payer: UnitedHealthcare Community & State	$20.70
Rate for Payer: Wellpoint Medicaid Managed Care	$18.61

WC LEVEL 3 FOLLOWUP VIST+MOD25

Facility

$655.20

Service Code	HCPCS 9921325
Hospital Charge Code	9800380
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

WC LEVEL 3 I&D DR BELOW FASCIA

Facility

$8,475.00

Service Code	HCPCS 28002
Hospital Charge Code	9800035
Hospital Revenue Code	510
Min. Negotiated Rate	$65.34
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,203.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25
Rate for Payer: UnitedHealthcare Community & State	$267.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$240.69

WC LEVEL 3 I&D DR BELOW FASCIA

Facility

$8,475.00

Service Code	HCPCS 28002
Hospital Charge Code	9800035
Hospital Revenue Code	510
Min. Negotiated Rate	$1,271.25
Max. Negotiated Rate	$1,271.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25

WC LEVEL 3 I&D DR BURSA FOOT

Facility

$3,954.00

Service Code	HCPCS 28001
Hospital Charge Code	9800030
Hospital Revenue Code	510
Min. Negotiated Rate	$32.67
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.04
Rate for Payer: Qualcare PPO/HMO/WC	$593.10
Rate for Payer: UnitedHealthcare Community & State	$124.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$112.29

WC LEVEL 3 I&D DR BURSA FOOT

Facility

$3,954.00

Service Code	HCPCS 28001
Hospital Charge Code	9800030
Hospital Revenue Code	510
Min. Negotiated Rate	$593.10
Max. Negotiated Rate	$593.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.10

WC LEVEL 3 INITIAL VISIT+MOD25

Facility

$828.80

Service Code	HCPCS 9920325
Hospital Charge Code	9800305
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

WC LEVEL 3 INITIAL VISIT+MOD25

Facility

$828.80

Service Code	HCPCS 9920325
Hospital Charge Code	9800305
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

WC LEVEL 3 OUTPATIENT CONSULT

Facility

$245.50

Service Code	HCPCS 99243
Hospital Charge Code	9800340
Hospital Revenue Code	510
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$122.75
Rate for Payer: Aetna Commercial	$93.29
Rate for Payer: Aetna Medicare Advantage	$73.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.60
Rate for Payer: Cigna Commercial	$122.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.83
Rate for Payer: Qualcare PPO/HMO/WC	$36.83
Rate for Payer: UnitedHealthcare Community & State	$7.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.97

WC LEVEL 3 OUTPATIENT CONSULT

Facility

$245.50

Service Code	HCPCS 99243
Hospital Charge Code	9800340
Hospital Revenue Code	510
Min. Negotiated Rate	$36.83
Max. Negotiated Rate	$36.83
Rate for Payer: Qualcare PPO/HMO/WC	$36.83

WC LEVEL 4 FOLLOWUP VIST+MOD2

Facility

$828.80

Service Code	HCPCS 9921425
Hospital Charge Code	9800390
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

WC LEVEL 4 FOLLOWUP VIST+MOD2

Facility

$828.80

Service Code	HCPCS 9921425
Hospital Charge Code	9800390
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

Know your out-of-pocket cost for care.

All Charges