Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OT FINGER SPLINT DYNAM RT

Facility

$351.00

Service Code	HCPCS 29131GO
Hospital Charge Code	74203015
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 STAT - BIL

Facility

$351.00

Service Code	HCPCS 29130GO
Hospital Charge Code	74203125
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 STAT - BIL

Facility

$351.00

Service Code	HCPCS 29130GO
Hospital Charge Code	74203125
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 STATI -LT

Facility

$351.00

Service Code	HCPCS 29130GO
Hospital Charge Code	74203127
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 STATI -LT

Facility

$351.00

Service Code	HCPCS 29130GO
Hospital Charge Code	74203127
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 STATI RT

Facility

$351.00

Service Code	HCPCS 29130GO
Hospital Charge Code	74203013
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 STATI RT

Facility

$351.00

Service Code	HCPCS 29130GO
Hospital Charge Code	74203013
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 FLUIDOTHERAPY

Facility

$77.65

Service Code	HCPCS 97022GO
Hospital Charge Code	9100054
Hospital Revenue Code	430
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

OT FLUIDOTHERAPY

Facility

$77.65

Service Code	HCPCS 97022GO
Hospital Charge Code	9100054
Hospital Revenue Code	430
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$29.51
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
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	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.19
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.45
Rate for Payer: Wellpoint Medicaid Managed Care	$2.21

OT FUNC ACT THER EA 15 MIN

Facility

$244.50

Service Code	HCPCS 97530GO
Hospital Charge Code	9100036
Hospital Revenue Code	430
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$36.67
Rate for Payer: Qualcare PPO/HMO/WC	$36.67

OT FUNC ACT THER EA 15 MIN

Facility

$244.50

Service Code	HCPCS 97530GO
Hospital Charge Code	9100036
Hospital Revenue Code	430
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$92.91
Rate for Payer: Aetna Medicare Advantage	$73.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.35
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	$62.35
Rate for Payer: Cigna Commercial	$122.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.57
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.67
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.73
Rate for Payer: Wellpoint Medicaid Managed Care	$6.94

OT FUNCTIONAL 15MIN

Facility

$245.00

Service Code	HCPCS 97530GO
Hospital Charge Code	74203057
Hospital Revenue Code	430
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

OT FUNCTIONAL 15MIN

Facility

$245.00

Service Code	HCPCS 97530GO
Hospital Charge Code	74203057
Hospital Revenue Code	430
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
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	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.70
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.74
Rate for Payer: Wellpoint Medicaid Managed Care	$6.96

OT FUNCTIONAL AMBUL 15MIN

Facility

$412.61

Service Code	HCPCS 97116GO
Hospital Charge Code	74203049
Hospital Revenue Code	430
Min. Negotiated Rate	$61.89
Max. Negotiated Rate	$61.89
Rate for Payer: Qualcare PPO/HMO/WC	$61.89

OT FUNCTIONAL AMBUL 15MIN

Facility

$412.61

Service Code	HCPCS 97116GO
Hospital Charge Code	74203049
Hospital Revenue Code	430
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$156.79
Rate for Payer: Aetna Medicare Advantage	$123.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.22
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	$105.22
Rate for Payer: Cigna Commercial	$206.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.28
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.89
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$13.04
Rate for Payer: Wellpoint Medicaid Managed Care	$11.72

OTHER AFTERCARE AND CONVALESCENCE

Facility

$6,236.87

Service Code	APR-DRG 8622
Min. Negotiated Rate	$6,114.58
Max. Negotiated Rate	$6,236.87
Rate for Payer: UnitedHealthcare Community & State	$6,114.58
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,236.87
Rate for Payer: Wellpoint Medicaid Managed Care	$6,114.58

OTHER AFTERCARE AND CONVALESCENCE

Facility

$8,006.40

Service Code	APR-DRG 8623
Min. Negotiated Rate	$7,849.41
Max. Negotiated Rate	$8,006.40
Rate for Payer: UnitedHealthcare Community & State	$7,849.41
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,006.40
Rate for Payer: Wellpoint Medicaid Managed Care	$7,849.41

OTHER AFTERCARE AND CONVALESCENCE

Facility

$4,468.73

Service Code	APR-DRG 8621
Min. Negotiated Rate	$4,381.11
Max. Negotiated Rate	$4,468.73
Rate for Payer: UnitedHealthcare Community & State	$4,381.11
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,468.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4,381.11

OTHER AFTERCARE AND CONVALESCENCE

Facility

$8,406.64

Service Code	APR-DRG 8624
Min. Negotiated Rate	$8,241.80
Max. Negotiated Rate	$8,406.64
Rate for Payer: UnitedHealthcare Community & State	$8,241.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,406.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8,241.80

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$10,079.27

Service Code	APR-DRG 2532
Min. Negotiated Rate	$9,881.64
Max. Negotiated Rate	$10,079.27
Rate for Payer: UnitedHealthcare Community & State	$9,881.64
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,079.27
Rate for Payer: Wellpoint Medicaid Managed Care	$9,881.64

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$14,331.72

Service Code	APR-DRG 2533
Min. Negotiated Rate	$14,050.71
Max. Negotiated Rate	$14,331.72
Rate for Payer: UnitedHealthcare Community & State	$14,050.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,331.72
Rate for Payer: Wellpoint Medicaid Managed Care	$14,050.71

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$7,814.01

Service Code	APR-DRG 2531
Min. Negotiated Rate	$7,660.79
Max. Negotiated Rate	$7,814.01
Rate for Payer: UnitedHealthcare Community & State	$7,660.79
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,814.01
Rate for Payer: Wellpoint Medicaid Managed Care	$7,660.79

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$24,659.51

Service Code	APR-DRG 2534
Min. Negotiated Rate	$24,175.99
Max. Negotiated Rate	$24,659.51
Rate for Payer: UnitedHealthcare Community & State	$24,175.99
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,659.51
Rate for Payer: Wellpoint Medicaid Managed Care	$24,175.99

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$13,083.19

Service Code	APR-DRG 6633
Min. Negotiated Rate	$12,826.66
Max. Negotiated Rate	$13,083.19
Rate for Payer: UnitedHealthcare Community & State	$12,826.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,083.19
Rate for Payer: Wellpoint Medicaid Managed Care	$12,826.66

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$22,314.24

Service Code	APR-DRG 6634
Min. Negotiated Rate	$21,876.71
Max. Negotiated Rate	$22,314.24
Rate for Payer: UnitedHealthcare Community & State	$21,876.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,314.24
Rate for Payer: Wellpoint Medicaid Managed Care	$21,876.71

Know your out-of-pocket cost for care.

All Charges