Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OTHER PT/OT GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8991GOCM
Hospital Charge Code	74203113CM
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

OTHER PT/OT GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8991GOCN
Hospital Charge Code	74203113CN
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER PT/OT GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8991GPCN
Hospital Charge Code	84202065CN
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER PT/OT GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8991GPCN
Hospital Charge Code	84202065CN
Hospital Revenue Code	420
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

OTHER PT/OT GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8991GOCN
Hospital Charge Code	74203113CN
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

OTHER PT/OT STATUS

Facility

$0.01

Service Code	HCPCS G8992GP
Hospital Charge Code	84201134
Hospital Revenue Code	429
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER PT/OT STATUS

Facility

$0.01

Service Code	HCPCS G8992GP
Hospital Charge Code	84201134
Hospital Revenue Code	429
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$18,386.17

Service Code	APR-DRG 1211
Min. Negotiated Rate	$18,025.66
Max. Negotiated Rate	$18,386.17
Rate for Payer: UnitedHealthcare Community & State	$18,025.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,386.17
Rate for Payer: Wellpoint Medicaid Managed Care	$18,025.66

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$62,235.16

Service Code	APR-DRG 1214
Min. Negotiated Rate	$61,014.86
Max. Negotiated Rate	$62,235.16
Rate for Payer: UnitedHealthcare Community & State	$61,014.86
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$62,235.16
Rate for Payer: Wellpoint Medicaid Managed Care	$61,014.86

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$36,404.35

Service Code	APR-DRG 1213
Min. Negotiated Rate	$35,690.54
Max. Negotiated Rate	$36,404.35
Rate for Payer: UnitedHealthcare Community & State	$35,690.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$36,404.35
Rate for Payer: Wellpoint Medicaid Managed Care	$35,690.54

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$23,804.23

Service Code	APR-DRG 1212
Min. Negotiated Rate	$23,337.48
Max. Negotiated Rate	$23,804.23
Rate for Payer: UnitedHealthcare Community & State	$23,337.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,804.23
Rate for Payer: Wellpoint Medicaid Managed Care	$23,337.48

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$23,055.74

Service Code	APR-DRG 1434
Min. Negotiated Rate	$22,603.67
Max. Negotiated Rate	$23,055.74
Rate for Payer: UnitedHealthcare Community & State	$22,603.67
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,055.74
Rate for Payer: Wellpoint Medicaid Managed Care	$22,603.67

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$9,709.90

Service Code	APR-DRG 1432
Min. Negotiated Rate	$9,519.51
Max. Negotiated Rate	$9,709.90
Rate for Payer: UnitedHealthcare Community & State	$9,519.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,709.90
Rate for Payer: Wellpoint Medicaid Managed Care	$9,519.51

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$14,366.81

Service Code	APR-DRG 1433
Min. Negotiated Rate	$14,085.11
Max. Negotiated Rate	$14,366.81
Rate for Payer: UnitedHealthcare Community & State	$14,085.11
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,366.81
Rate for Payer: Wellpoint Medicaid Managed Care	$14,085.11

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$6,948.89

Service Code	APR-DRG 1431
Min. Negotiated Rate	$6,812.64
Max. Negotiated Rate	$6,948.89
Rate for Payer: UnitedHealthcare Community & State	$6,812.64
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,948.89
Rate for Payer: Wellpoint Medicaid Managed Care	$6,812.64

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$77,312.45

Service Code	MSDRG 205
Min. Negotiated Rate	$23,540.65
Max. Negotiated Rate	$77,312.45
Rate for Payer: Aetna Commercial	$56,921.33
Rate for Payer: Aetna Medicare Advantage	$77,312.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50,146.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50,146.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,779.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50,146.05
Rate for Payer: Cigna Commercial	$40,818.48
Rate for Payer: Cigna Medicare Advantage	$24,779.63
Rate for Payer: Clover Medicare Advantage	$23,540.65
Rate for Payer: EmblemHealth Commercial	$74,338.89
Rate for Payer: Humana Medicare Advantage	$25,523.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,779.63
Rate for Payer: Oxford Commercial	$32,262.22
Rate for Payer: UnitedHealthcare Commercial	$43,184.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,779.63
Rate for Payer: Wellcare Medicare Advantage	$24,779.63

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$49,197.38

Service Code	MSDRG 206
Min. Negotiated Rate	$14,979.97
Max. Negotiated Rate	$49,197.38
Rate for Payer: Aetna Commercial	$36,897.44
Rate for Payer: Aetna Medicare Advantage	$49,197.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,211.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,211.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,768.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,211.55
Rate for Payer: Cigna Commercial	$20,979.94
Rate for Payer: Cigna Medicare Advantage	$15,768.39
Rate for Payer: Clover Medicare Advantage	$14,979.97
Rate for Payer: EmblemHealth Commercial	$47,305.17
Rate for Payer: Humana Medicare Advantage	$16,241.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,768.39
Rate for Payer: Oxford Commercial	$16,582.18
Rate for Payer: UnitedHealthcare Commercial	$22,195.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,768.39
Rate for Payer: Wellcare Medicare Advantage	$15,768.39

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$76,440.50

Service Code	MSDRG 167
Min. Negotiated Rate	$23,275.15
Max. Negotiated Rate	$76,440.50
Rate for Payer: Aetna Commercial	$56,300.30
Rate for Payer: Aetna Medicare Advantage	$76,440.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50,423.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50,423.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,500.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50,423.10
Rate for Payer: Cigna Commercial	$40,203.20
Rate for Payer: Cigna Medicare Advantage	$24,500.16
Rate for Payer: Clover Medicare Advantage	$23,275.15
Rate for Payer: EmblemHealth Commercial	$73,500.48
Rate for Payer: Humana Medicare Advantage	$25,235.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,500.16
Rate for Payer: Oxford Commercial	$31,775.91
Rate for Payer: UnitedHealthcare Commercial	$42,533.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,500.16
Rate for Payer: Wellcare Medicare Advantage	$24,500.16

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$137,551.94

Service Code	MSDRG 166
Min. Negotiated Rate	$41,882.80
Max. Negotiated Rate	$137,551.94
Rate for Payer: Aetna Commercial	$99,824.58
Rate for Payer: Aetna Medicare Advantage	$137,551.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112,482.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112,482.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44,087.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112,482.30
Rate for Payer: Cigna Commercial	$83,324.55
Rate for Payer: Cigna Medicare Advantage	$44,087.16
Rate for Payer: Clover Medicare Advantage	$41,882.80
Rate for Payer: EmblemHealth Commercial	$132,261.48
Rate for Payer: Humana Medicare Advantage	$45,409.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44,087.16
Rate for Payer: Oxford Commercial	$65,858.27
Rate for Payer: UnitedHealthcare Commercial	$88,153.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$44,087.16
Rate for Payer: Wellcare Medicare Advantage	$44,087.16

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$62,634.09

Service Code	MSDRG 168
Min. Negotiated Rate	$19,071.28
Max. Negotiated Rate	$62,634.09
Rate for Payer: Aetna Commercial	$46,467.24
Rate for Payer: Aetna Medicare Advantage	$62,634.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,678.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,678.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,075.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,678.80
Rate for Payer: Cigna Commercial	$30,461.16
Rate for Payer: Cigna Medicare Advantage	$20,075.03
Rate for Payer: Clover Medicare Advantage	$19,071.28
Rate for Payer: EmblemHealth Commercial	$60,225.09
Rate for Payer: Humana Medicare Advantage	$20,677.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,075.03
Rate for Payer: Oxford Commercial	$24,075.97
Rate for Payer: UnitedHealthcare Commercial	$32,226.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,075.03
Rate for Payer: Wellcare Medicare Advantage	$20,075.03

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$19,228.78

Service Code	APR-DRG 3091
Min. Negotiated Rate	$18,851.75
Max. Negotiated Rate	$19,228.78
Rate for Payer: UnitedHealthcare Community & State	$18,851.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,228.78
Rate for Payer: Wellpoint Medicaid Managed Care	$18,851.75

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$35,113.75

Service Code	APR-DRG 3093
Min. Negotiated Rate	$34,425.25
Max. Negotiated Rate	$35,113.75
Rate for Payer: UnitedHealthcare Community & State	$34,425.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,113.75
Rate for Payer: Wellpoint Medicaid Managed Care	$34,425.25

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$24,960.09

Service Code	APR-DRG 3092
Min. Negotiated Rate	$24,470.68
Max. Negotiated Rate	$24,960.09
Rate for Payer: UnitedHealthcare Community & State	$24,470.68
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,960.09
Rate for Payer: Wellpoint Medicaid Managed Care	$24,470.68

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$55,053.17

Service Code	APR-DRG 3094
Min. Negotiated Rate	$53,973.70
Max. Negotiated Rate	$55,053.17
Rate for Payer: UnitedHealthcare Community & State	$53,973.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$55,053.17
Rate for Payer: Wellpoint Medicaid Managed Care	$53,973.70

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$5,926.47

Service Code	APR-DRG 3851
Min. Negotiated Rate	$5,810.26
Max. Negotiated Rate	$5,926.47
Rate for Payer: UnitedHealthcare Community & State	$5,810.26
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,926.47
Rate for Payer: Wellpoint Medicaid Managed Care	$5,810.26

Know your out-of-pocket cost for care.

All Charges