Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OTHER SLP GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9175GNCN
Hospital Charge Code	74204091CN
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OTHER SLP GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9175GNCN
Hospital Charge Code	74204091CN
Hospital Revenue Code	440
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) 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 SMALL AND LARGE BOWEL PROCEDURES

Facility

$16,339.94

Service Code	APR-DRG 2231
Min. Negotiated Rate	$16,019.55
Max. Negotiated Rate	$16,339.94
Rate for Payer: UnitedHealthcare Community & State	$16,019.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,339.94
Rate for Payer: Wellpoint Medicaid Managed Care	$16,019.55

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$50,174.31

Service Code	APR-DRG 2234
Min. Negotiated Rate	$49,190.50
Max. Negotiated Rate	$50,174.31
Rate for Payer: UnitedHealthcare Community & State	$49,190.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$50,174.31
Rate for Payer: Wellpoint Medicaid Managed Care	$49,190.50

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$27,607.32

Service Code	APR-DRG 2233
Min. Negotiated Rate	$27,066.00
Max. Negotiated Rate	$27,607.32
Rate for Payer: UnitedHealthcare Community & State	$27,066.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27,607.32
Rate for Payer: Wellpoint Medicaid Managed Care	$27,066.00

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$20,291.90

Service Code	APR-DRG 2232
Min. Negotiated Rate	$19,894.02
Max. Negotiated Rate	$20,291.90
Rate for Payer: UnitedHealthcare Community & State	$19,894.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,291.90
Rate for Payer: Wellpoint Medicaid Managed Care	$19,894.02

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$17,563.21

Service Code	APR-DRG 2222
Min. Negotiated Rate	$17,218.83
Max. Negotiated Rate	$17,563.21
Rate for Payer: UnitedHealthcare Community & State	$17,218.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,563.21
Rate for Payer: Wellpoint Medicaid Managed Care	$17,218.83

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$25,872.95

Service Code	APR-DRG 2223
Min. Negotiated Rate	$25,365.64
Max. Negotiated Rate	$25,872.95
Rate for Payer: UnitedHealthcare Community & State	$25,365.64
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,872.95
Rate for Payer: Wellpoint Medicaid Managed Care	$25,365.64

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$10,121.34

Service Code	APR-DRG 2221
Min. Negotiated Rate	$9,922.88
Max. Negotiated Rate	$10,121.34
Rate for Payer: UnitedHealthcare Community & State	$9,922.88
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,121.34
Rate for Payer: Wellpoint Medicaid Managed Care	$9,922.88

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$50,816.16

Service Code	APR-DRG 2224
Min. Negotiated Rate	$49,819.76
Max. Negotiated Rate	$50,816.16
Rate for Payer: UnitedHealthcare Community & State	$49,819.76
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$50,816.16
Rate for Payer: Wellpoint Medicaid Managed Care	$49,819.76

OTHER VASCULAR PROCEDURES WITH CC

Facility

$101,468.92

Service Code	MSDRG 253
Min. Negotiated Rate	$30,895.99
Max. Negotiated Rate	$101,468.92
Rate for Payer: Aetna Commercial	$74,125.83
Rate for Payer: Aetna Medicare Advantage	$101,468.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70,647.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70,647.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$32,522.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70,647.75
Rate for Payer: Cigna Commercial	$57,863.71
Rate for Payer: Cigna Medicare Advantage	$32,522.09
Rate for Payer: Clover Medicare Advantage	$30,895.99
Rate for Payer: EmblemHealth Commercial	$97,566.27
Rate for Payer: Humana Medicare Advantage	$33,497.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$32,522.09
Rate for Payer: Oxford Commercial	$45,734.47
Rate for Payer: UnitedHealthcare Commercial	$61,217.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$32,522.09
Rate for Payer: Wellcare Medicare Advantage	$32,522.09

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$129,672.44

Service Code	MSDRG 252
Min. Negotiated Rate	$39,483.60
Max. Negotiated Rate	$129,672.44
Rate for Payer: Aetna Commercial	$94,212.72
Rate for Payer: Aetna Medicare Advantage	$129,672.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92,811.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92,811.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$41,561.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92,811.75
Rate for Payer: Cigna Commercial	$77,764.67
Rate for Payer: Cigna Medicare Advantage	$41,561.68
Rate for Payer: Clover Medicare Advantage	$39,483.60
Rate for Payer: EmblemHealth Commercial	$124,685.04
Rate for Payer: Humana Medicare Advantage	$42,808.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$41,561.68
Rate for Payer: Oxford Commercial	$61,463.85
Rate for Payer: UnitedHealthcare Commercial	$82,271.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$41,561.68
Rate for Payer: Wellcare Medicare Advantage	$41,561.68

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$75,754.94

Service Code	MSDRG 254
Min. Negotiated Rate	$23,066.41
Max. Negotiated Rate	$75,754.94
Rate for Payer: Aetna Commercial	$55,812.03
Rate for Payer: Aetna Medicare Advantage	$75,754.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48,206.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48,206.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,280.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48,206.70
Rate for Payer: Cigna Commercial	$39,719.44
Rate for Payer: Cigna Medicare Advantage	$24,280.43
Rate for Payer: Clover Medicare Advantage	$23,066.41
Rate for Payer: EmblemHealth Commercial	$72,841.29
Rate for Payer: Humana Medicare Advantage	$25,008.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,280.43
Rate for Payer: Oxford Commercial	$31,393.55
Rate for Payer: UnitedHealthcare Commercial	$42,021.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,280.43
Rate for Payer: Wellcare Medicare Advantage	$24,280.43

OT HOME MGT SELFCAR 15MIN

Facility

$384.00

Service Code	HCPCS 97535GO
Hospital Charge Code	74203063
Hospital Revenue Code	430
Min. Negotiated Rate	$10.91
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$145.92
Rate for Payer: Aetna Medicare Advantage	$115.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.92
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	$97.92
Rate for Payer: Cigna Commercial	$192.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.84
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.60
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$12.13
Rate for Payer: Wellpoint Medicaid Managed Care	$10.91

OT HOME MGT SELFCAR 15MIN

Facility

$384.00

Service Code	HCPCS 97535GO
Hospital Charge Code	74203063
Hospital Revenue Code	430
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

OT IONTOPHORESIS EA 15 MIN

Facility

$77.65

Service Code	HCPCS 97033GO
Hospital Charge Code	9100056
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 IONTOPHORESIS EA 15 MIN

Facility

$77.65

Service Code	HCPCS 97033GO
Hospital Charge Code	9100056
Hospital Revenue Code	430
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

OT IONTO UNATTENDED 15MIN

Facility

$132.00

Service Code	HCPCS 97033GO
Hospital Charge Code	74203037
Hospital Revenue Code	430
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$50.16
Rate for Payer: Aetna Medicare Advantage	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.66
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	$33.66
Rate for Payer: Cigna Commercial	$66.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.32
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.80
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.17
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

OT IONTO UNATTENDED 15MIN

Facility

$132.00

Service Code	HCPCS 97033GO
Hospital Charge Code	74203037
Hospital Revenue Code	430
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$19.80

OTIRX 10ML

Facility

$122.14

Service Code	NDC 42192010804
Hospital Charge Code	60635362
Hospital Revenue Code	250
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$18.32
Rate for Payer: Qualcare PPO/HMO/WC	$18.32

OTIRX 10ML

Facility

$122.14

Service Code	NDC 42192010804
Hospital Charge Code	60635362
Hospital Revenue Code	250
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$61.07
Rate for Payer: Aetna Commercial	$46.41
Rate for Payer: Aetna Medicare Advantage	$36.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.15
Rate for Payer: Cigna Commercial	$61.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.76
Rate for Payer: Oxford Commercial	$24.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.32
Rate for Payer: UnitedHealthcare Commercial	$24.43
Rate for Payer: UnitedHealthcare Community & State	$3.86
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

OTITIS MEDIA AND URI WITH MCC

Facility

$56,814.58

Service Code	MSDRG 152
Min. Negotiated Rate	$17,299.31
Max. Negotiated Rate	$56,814.58
Rate for Payer: Aetna Commercial	$42,322.52
Rate for Payer: Aetna Medicare Advantage	$56,814.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32,968.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32,968.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,209.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32,968.95
Rate for Payer: Cigna Commercial	$26,354.78
Rate for Payer: Cigna Medicare Advantage	$18,209.80
Rate for Payer: Clover Medicare Advantage	$17,299.31
Rate for Payer: EmblemHealth Commercial	$54,629.40
Rate for Payer: Humana Medicare Advantage	$18,756.09
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,209.80
Rate for Payer: Oxford Commercial	$20,830.36
Rate for Payer: UnitedHealthcare Commercial	$27,882.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,209.80
Rate for Payer: Wellcare Medicare Advantage	$18,209.80

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$42,786.99

Service Code	MSDRG 153
Min. Negotiated Rate	$13,007.08
Max. Negotiated Rate	$42,786.99
Rate for Payer: Aetna Commercial	$32,331.88
Rate for Payer: Aetna Medicare Advantage	$42,786.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,224.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,224.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,713.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,224.65
Rate for Payer: Cigna Commercial	$16,456.69
Rate for Payer: Cigna Medicare Advantage	$13,713.78
Rate for Payer: Clover Medicare Advantage	$13,028.09
Rate for Payer: EmblemHealth Commercial	$41,141.34
Rate for Payer: Humana Medicare Advantage	$14,125.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,713.78
Rate for Payer: Oxford Commercial	$13,007.08
Rate for Payer: UnitedHealthcare Commercial	$17,410.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,713.78
Rate for Payer: Wellcare Medicare Advantage	$13,713.78

OT MANUAL THERAPY 15MIN

Facility

$159.00

Service Code	HCPCS 97140GO
Hospital Charge Code	74203053
Hospital Revenue Code	430
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

OT MANUAL THERAPY 15MIN

Facility

$159.00

Service Code	HCPCS 97140GO
Hospital Charge Code	74203053
Hospital Revenue Code	430
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$60.42
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.55
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	$40.55
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.34
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.52

Know your out-of-pocket cost for care.

All Charges