Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INDIVIDUAL THERAPY INTENSIVE

Facility

$671.00

Service Code	HCPCS 90808
Hospital Charge Code	83246015
Hospital Revenue Code	914
Min. Negotiated Rate	$100.65
Max. Negotiated Rate	$100.65
Rate for Payer: Qualcare PPO/HMO/WC	$100.65

INDIVIDUAL THERAPY STANDARD

Facility

$1,423.80

Service Code	HCPCS 90806
Hospital Charge Code	83246010
Hospital Revenue Code	914
Min. Negotiated Rate	$213.57
Max. Negotiated Rate	$213.57
Rate for Payer: Qualcare PPO/HMO/WC	$213.57

INDIVIDUAL THERAPY STANDARD

Facility

$1,423.80

Service Code	HCPCS 90806
Hospital Charge Code	83246010
Hospital Revenue Code	914
Min. Negotiated Rate	$40.44
Max. Negotiated Rate	$711.90
Rate for Payer: Aetna Commercial	$541.04
Rate for Payer: Aetna Medicare Advantage	$427.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.07
Rate for Payer: Cigna Commercial	$711.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.19
Rate for Payer: Qualcare PPO/HMO/WC	$213.57
Rate for Payer: UnitedHealthcare Community & State	$44.99
Rate for Payer: Wellpoint Medicaid Managed Care	$40.44

INDIV NUTR INIT ASSES 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97802
Hospital Charge Code	9300001
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

INDIV NUTR INIT ASSES 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97802
Hospital Charge Code	9300001
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

INDIV NUTR REASSES 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97803
Hospital Charge Code	9300002
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

INDIV NUTR REASSES 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97803
Hospital Charge Code	9300002
Hospital Revenue Code	942
Min. Negotiated Rate	$19.80
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	$19.80
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

INDIV.THERAPY 20-30 MTS

Facility

$1,296.00

Service Code	HCPCS 90804
Hospital Charge Code	84504020
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

INDIV.THERAPY 20-30 MTS

Facility

$1,296.00

Service Code	HCPCS 90804
Hospital Charge Code	84504020
Hospital Revenue Code	914
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$492.48
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.96
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Community & State	$40.95
Rate for Payer: Wellpoint Medicaid Managed Care	$36.81

INDOCIN 50MG SUPP

Facility

$1,136.52

Service Code	NDC 69344010233
Hospital Charge Code	60630246
Hospital Revenue Code	250
Min. Negotiated Rate	$170.48
Max. Negotiated Rate	$170.48
Rate for Payer: Qualcare PPO/HMO/WC	$170.48

INDOCIN 50MG SUPP

Facility

$1,136.52

Service Code	NDC 69344010233
Hospital Charge Code	60630246
Hospital Revenue Code	250
Min. Negotiated Rate	$32.28
Max. Negotiated Rate	$568.26
Rate for Payer: Aetna Commercial	$431.88
Rate for Payer: Aetna Medicare Advantage	$340.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.81
Rate for Payer: Cigna Commercial	$568.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.50
Rate for Payer: Oxford Commercial	$227.30
Rate for Payer: Qualcare PPO/HMO/WC	$170.48
Rate for Payer: UnitedHealthcare Commercial	$227.30
Rate for Payer: UnitedHealthcare Community & State	$35.91
Rate for Payer: Wellpoint Medicaid Managed Care	$32.28

INDOCYANINE GREEN

Facility

$916.02

Service Code	NDC 17478070102
Hospital Charge Code	60635705
Hospital Revenue Code	250
Min. Negotiated Rate	$26.01
Max. Negotiated Rate	$458.01
Rate for Payer: Aetna Commercial	$348.09
Rate for Payer: Aetna Medicare Advantage	$274.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$233.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$233.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$233.59
Rate for Payer: Cigna Commercial	$458.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.17
Rate for Payer: Oxford Commercial	$183.20
Rate for Payer: Qualcare PPO/HMO/WC	$137.40
Rate for Payer: UnitedHealthcare Commercial	$183.20
Rate for Payer: UnitedHealthcare Community & State	$28.95
Rate for Payer: Wellpoint Medicaid Managed Care	$26.01

INDOCYANINE GREEN

Facility

$916.02

Service Code	NDC 17478070102
Hospital Charge Code	60635705
Hospital Revenue Code	250
Min. Negotiated Rate	$137.40
Max. Negotiated Rate	$137.40
Rate for Payer: Qualcare PPO/HMO/WC	$137.40

INDOMETHACIN 25 MG CAP

Facility

$4.00

Service Code	NDC 93402901
Hospital Charge Code	60627684
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

INDOMETHACIN 25 MG CAP

Facility

$4.00

Service Code	NDC 93402901
Hospital Charge Code	60627684
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

INDOMETHACIN 50MG CAPSULE

Facility

$4.56

Service Code	NDC 51079019120
Hospital Charge Code	60632345
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

INDOMETHACIN 50MG CAPSULE

Facility

$4.56

Service Code	NDC 51079019120
Hospital Charge Code	60632345
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.28
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: Aetna Medicare Advantage	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.16
Rate for Payer: Cigna Commercial	$2.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.19
Rate for Payer: Oxford Commercial	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.91
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

IND PSYCHOTX 60 MIN

Facility

$2,000.00

Service Code	HCPCS 90837
Hospital Charge Code	412390837
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

IND PSYCHOTX 60 MIN

Facility

$2,000.00

Service Code	HCPCS 90837
Hospital Charge Code	412390837
Hospital Revenue Code	914
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$520.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

IND PSYCHOTX MD 30MIN

Facility

$375.00

Service Code	HCPCS 90832
Hospital Charge Code	4504701
Hospital Revenue Code	914
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

IND PSYCHOTX MD 30MIN

Facility

$375.00

Service Code	HCPCS 90832
Hospital Charge Code	4527701
Hospital Revenue Code	914
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

IND PSYCHOTX MD 30MIN

Facility

$375.00

Service Code	HCPCS 90832
Hospital Charge Code	4504701
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX MD 30MIN

Facility

$375.00

Service Code	HCPCS 90832
Hospital Charge Code	4511701
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX MD 30MIN

Facility

$375.00

Service Code	HCPCS 90832
Hospital Charge Code	4509701
Hospital Revenue Code	914
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

IND PSYCHOTX MD 30MIN

Facility

$375.00

Service Code	HCPCS 90832
Hospital Charge Code	4502701
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

Know your out-of-pocket cost for care.

All Charges