Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WC LEVEL 4 INITIAL VISIT+MOD25

Facility

$1,068.20

Service Code	HCPCS 9920425
Hospital Charge Code	9800315
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

WC LEVEL 4 INITIAL VISIT+MOD25

Facility

$1,068.20

Service Code	HCPCS 9920425
Hospital Charge Code	9800315
Hospital Revenue Code	510
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$405.92
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.73
Rate for Payer: Qualcare PPO/HMO/WC	$160.23
Rate for Payer: UnitedHealthcare Community & State	$33.76
Rate for Payer: Wellpoint Medicaid Managed Care	$30.34

WC LEVEL 4 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99244
Hospital Charge Code	9800345
Hospital Revenue Code	510
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$174.25
Rate for Payer: Aetna Commercial	$132.43
Rate for Payer: Aetna Medicare Advantage	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.87
Rate for Payer: Cigna Commercial	$174.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.61
Rate for Payer: Qualcare PPO/HMO/WC	$52.27
Rate for Payer: UnitedHealthcare Community & State	$11.01
Rate for Payer: Wellpoint Medicaid Managed Care	$9.90

WC LEVEL 4 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99244
Hospital Charge Code	9800345
Hospital Revenue Code	510
Min. Negotiated Rate	$52.27
Max. Negotiated Rate	$52.27
Rate for Payer: Qualcare PPO/HMO/WC	$52.27

WC LEVEL 5 FOLLOWUP VIST+MOD25

Facility

$1,213.80

Service Code	HCPCS 9921525
Hospital Charge Code	9800400
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

WC LEVEL 5 FOLLOWUP VIST+MOD25

Facility

$1,213.80

Service Code	HCPCS 9921525
Hospital Charge Code	9800400
Hospital Revenue Code	510
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.59
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$38.36
Rate for Payer: Wellpoint Medicaid Managed Care	$34.47

WC LEVEL 5 INITIAL VISIT+MOD25

Facility

$1,450.00

Service Code	HCPCS 9920525
Hospital Charge Code	9800325
Hospital Revenue Code	510
Min. Negotiated Rate	$41.18
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$45.82
Rate for Payer: Wellpoint Medicaid Managed Care	$41.18

WC LEVEL 5 INITIAL VISIT+MOD25

Facility

$1,450.00

Service Code	HCPCS 9920525
Hospital Charge Code	9800325
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

WC LEVEL 5 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99245
Hospital Charge Code	9800350
Hospital Revenue Code	510
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$174.25
Rate for Payer: Aetna Commercial	$132.43
Rate for Payer: Aetna Medicare Advantage	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.87
Rate for Payer: Cigna Commercial	$174.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.61
Rate for Payer: Qualcare PPO/HMO/WC	$52.27
Rate for Payer: UnitedHealthcare Community & State	$11.01
Rate for Payer: Wellpoint Medicaid Managed Care	$9.90

WC LEVEL 5 OUTPATIENT CONSULT

Facility

$348.50

Service Code	HCPCS 99245
Hospital Charge Code	9800350
Hospital Revenue Code	510
Min. Negotiated Rate	$52.27
Max. Negotiated Rate	$52.27
Rate for Payer: Qualcare PPO/HMO/WC	$52.27

WC LOWER LEG SPLINT

Facility

$777.42

Service Code	HCPCS 29515
Hospital Charge Code	9800155
Hospital Revenue Code	510
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$116.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

WC LOWER LEG SPLINT

Facility

$777.42

Service Code	HCPCS 29515
Hospital Charge Code	9800155
Hospital Revenue Code	510
Min. Negotiated Rate	$22.08
Max. Negotiated Rate	$700.29
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$700.29
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.13
Rate for Payer: Qualcare PPO/HMO/WC	$116.61
Rate for Payer: UnitedHealthcare Community & State	$24.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$22.08

WC MARZUPIALXTN BATHOLYN CYST

Facility

$2,100.00

Service Code	HCPCS 56440
Hospital Charge Code	83652123
Hospital Revenue Code	361
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

WC MARZUPIALXTN BATHOLYN CYST

Facility

$2,100.00

Service Code	HCPCS 56440
Hospital Charge Code	83652123
Hospital Revenue Code	361
Min. Negotiated Rate	$59.64
Max. Negotiated Rate	$13,950.60
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,950.60
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.00
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$66.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$59.64

WC MED NUTRITION INIT 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97802
Hospital Charge Code	83652389
Hospital Revenue Code	942
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

WC MED NUTRITION INIT 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97802
Hospital Charge Code	83652389
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

WC MIRENA IUD

Facility

$284.00

Service Code	HCPCS J7298
Hospital Charge Code	83652621
Hospital Revenue Code	636
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$142.00
Rate for Payer: Aetna Commercial	$107.92
Rate for Payer: Aetna Medicare Advantage	$85.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.42
Rate for Payer: Cigna Commercial	$142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.73
Rate for Payer: Qualcare PPO/HMO/WC	$42.60
Rate for Payer: UnitedHealthcare Community & State	$8.97
Rate for Payer: Wellpoint Medicaid Managed Care	$8.07

WC MIRENA IUD

Facility

$284.00

Service Code	HCPCS J7298
Hospital Charge Code	83652621
Hospital Revenue Code	636
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$68.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.73
Rate for Payer: Qualcare PPO/HMO/WC	$42.60

WC MISSED A/B 1ST TRIMESTER

Professional

Both

$826.00

Service Code	HCPCS 59820
Hospital Charge Code	83652251
Hospital Revenue Code	960
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.00

WC NERVE BLOCK OTHER PERIPHERA

Facility

$1,587.00

Service Code	HCPCS 64450
Hospital Charge Code	9800415
Hospital Revenue Code	510
Min. Negotiated Rate	$238.05
Max. Negotiated Rate	$238.05
Rate for Payer: Qualcare PPO/HMO/WC	$238.05

WC NERVE BLOCK OTHER PERIPHERA

Facility

$1,587.00

Service Code	HCPCS 64450
Hospital Charge Code	9800415
Hospital Revenue Code	510
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$3,042.06
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,042.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,042.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,042.06
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.62
Rate for Payer: Qualcare PPO/HMO/WC	$238.05
Rate for Payer: UnitedHealthcare Community & State	$50.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$45.07

WC NON AHESIVE GAUZE W NS/HYDR

Facility

$7.00

Service Code	HCPCS A6222
Hospital Charge Code	9808155
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

WC NON AHESIVE GAUZE W NS/HYDR

Facility

$7.00

Service Code	HCPCS A6222
Hospital Charge Code	9808155
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

WC NP OV E&M FOCUSED PROBLEM

Facility

$140.80

Service Code	HCPCS 99201
Hospital Charge Code	83652393
Hospital Revenue Code	514
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$70.40
Rate for Payer: Aetna Commercial	$53.50
Rate for Payer: Aetna Medicare Advantage	$42.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.90
Rate for Payer: Cigna Commercial	$70.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Qualcare PPO/HMO/WC	$21.12
Rate for Payer: UnitedHealthcare Community & State	$4.45
Rate for Payer: Wellpoint Medicaid Managed Care	$4.00

WC NP OV E&M FOCUSED PROBLEM

Facility

$140.80

Service Code	HCPCS 99201
Hospital Charge Code	83652393
Hospital Revenue Code	514
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$21.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.12

Know your out-of-pocket cost for care.

All Charges