Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OT CONTRAST BATH EACH 15 MIN

Facility

$106.00

Service Code	HCPCS 97034GO
Hospital Charge Code	1008180
Hospital Revenue Code	430
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

OT CONTRAST BATH EACH 15 MIN

Facility

$106.00

Service Code	HCPCS 97034GO
Hospital Charge Code	1008180
Hospital Revenue Code	430
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$1,060.00
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) NJ Health	$69.00
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	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

OT CONTRAST BATHS 15MIN

Facility

$106.00

Service Code	HCPCS 97034GO
Hospital Charge Code	74203039
Hospital Revenue Code	430
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

OT CONTRAST BATHS 15MIN

Facility

$106.00

Service Code	HCPCS 97034GO
Hospital Charge Code	74203039
Hospital Revenue Code	430
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$1,060.00
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) NJ Health	$69.00
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	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

OT ELEC STIM ATTEND 15MIN

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	74203035
Hospital Revenue Code	430
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

OT ELEC STIM ATTEND 15MIN

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	74203035
Hospital Revenue Code	430
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$93.86
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
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	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.22
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.81
Rate for Payer: Wellpoint Medicaid Managed Care	$7.01

OT ELEC STIM MANUAL EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97032GO
Hospital Charge Code	9100050
Hospital Revenue Code	430
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
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	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.38
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.69
Rate for Payer: Wellpoint Medicaid Managed Care	$3.32

OT ELEC STIM MANUAL EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97032GO
Hospital Charge Code	9100050
Hospital Revenue Code	430
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

OT ELEC STIM UNATTENDED

Facility

$153.00

Service Code	HCPCS G0283GO
Hospital Charge Code	74203085
Hospital Revenue Code	430
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$58.14
Rate for Payer: Aetna Medicare Advantage	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.02
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	$39.02
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.78
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

OT ELEC STIM UNATTENDED

Facility

$153.00

Service Code	HCPCS G0283GO
Hospital Charge Code	74203085
Hospital Revenue Code	430
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

OT EVAL HIGH COMPLEX 60 MIN

Facility

$2,400.00

Service Code	HCPCS 97167GO
Hospital Charge Code	74203124
Hospital Revenue Code	434
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OT EVAL HIGH COMPLEX 60 MIN

Facility

$2,400.00

Service Code	HCPCS 97167GO
Hospital Charge Code	74203124
Hospital Revenue Code	434
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$65.00

OT EVAL LOW COMPLEX 30 MIN

Facility

$2,400.00

Service Code	HCPCS 97165GO
Hospital Charge Code	74203122
Hospital Revenue Code	434
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$65.00

OT EVAL LOW COMPLEX 30 MIN

Facility

$2,400.00

Service Code	HCPCS 97165GO
Hospital Charge Code	74203122
Hospital Revenue Code	434
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OT EVAL MOD COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97166GO
Hospital Charge Code	74203126
Hospital Revenue Code	434
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OT EVAL MOD COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97166GO
Hospital Charge Code	74203126
Hospital Revenue Code	434
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$65.00

OT EVALUATION

Facility

$523.00

Service Code	HCPCS 97003GO
Hospital Charge Code	74203021
Hospital Revenue Code	434
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$78.45
Rate for Payer: Qualcare PPO/HMO/WC	$78.45

OT EVALUATION

Facility

$523.00

Service Code	HCPCS 97003GO
Hospital Charge Code	74203021
Hospital Revenue Code	434
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$198.74
Rate for Payer: Aetna Medicare Advantage	$156.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.37
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	$133.37
Rate for Payer: Cigna Commercial	$261.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.98
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.45
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$16.53
Rate for Payer: Wellpoint Medicaid Managed Care	$65.00

OT EVALUATION

Facility

$332.85

Service Code	HCPCS 97003GO
Hospital Charge Code	9000431
Hospital Revenue Code	434
Min. Negotiated Rate	$10.52
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$126.48
Rate for Payer: Aetna Medicare Advantage	$99.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.88
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	$84.88
Rate for Payer: Cigna Commercial	$166.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.54
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.93
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$10.52
Rate for Payer: Wellpoint Medicaid Managed Care	$65.00

OT EVALUATION

Facility

$332.85

Service Code	HCPCS 97003GO
Hospital Charge Code	9000431
Hospital Revenue Code	434
Min. Negotiated Rate	$49.93
Max. Negotiated Rate	$49.93
Rate for Payer: Qualcare PPO/HMO/WC	$49.93

OT:FAMILY EDUCATION/CONF 15 MI

Facility

$60.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008315
Hospital Revenue Code	430
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
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	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.90
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

OT:FAMILY EDUCATION/CONF 15 MI

Facility

$60.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008315
Hospital Revenue Code	430
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

OT - FINGER SPLINT DYNAM - LT

Facility

$351.00

Service Code	HCPCS 29131GO
Hospital Charge Code	74203123
Hospital Revenue Code	430
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$133.38
Rate for Payer: Aetna Medicare Advantage	$105.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.50
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	$89.50
Rate for Payer: Cigna Commercial	$175.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.26
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.65
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$11.09
Rate for Payer: Wellpoint Medicaid Managed Care	$9.97

OT - FINGER SPLINT DYNAM - LT

Facility

$351.00

Service Code	HCPCS 29131GO
Hospital Charge Code	74203123
Hospital Revenue Code	430
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$52.65
Rate for Payer: Qualcare PPO/HMO/WC	$52.65

OT FINGER SPLINT DYNAM RT

Facility

$351.00

Service Code	HCPCS 29131GO
Hospital Charge Code	74203015
Hospital Revenue Code	430
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$52.65
Rate for Payer: Qualcare PPO/HMO/WC	$52.65

Know your out-of-pocket cost for care.

All Charges