Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OT MANUAL THERAPY EA 15 MIN

Facility

$159.00

Service Code	HCPCS 97140GO
Hospital Charge Code	9100170
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

OT MANUAL THERAPY EA 15 MIN

Facility

$159.00

Service Code	HCPCS 97140GO
Hospital Charge Code	9100170
Hospital Revenue Code	430
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

OT MASSAGE 15 MIN

Facility

$328.00

Service Code	HCPCS 97124GO
Hospital Charge Code	74203051
Hospital Revenue Code	430
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$124.64
Rate for Payer: Aetna Medicare Advantage	$98.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.64
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	$83.64
Rate for Payer: Cigna Commercial	$164.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.28
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.20
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.32

OT MASSAGE 15 MIN

Facility

$328.00

Service Code	HCPCS 97124GO
Hospital Charge Code	74203051
Hospital Revenue Code	430
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$49.20
Rate for Payer: Qualcare PPO/HMO/WC	$49.20

OT MODALITY ELC STM WOUND CARE

Facility

$91.25

Service Code	HCPCS G0281GO
Hospital Charge Code	9100166
Hospital Revenue Code	430
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
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	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.73
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.59

OT MODALITY ELC STM WOUND CARE

Facility

$91.25

Service Code	HCPCS G0281GO
Hospital Charge Code	9100166
Hospital Revenue Code	430
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

OT MODALITY ELEC STIM UNATTEND

Facility

$91.25

Service Code	HCPCS G0283GO
Hospital Charge Code	9100175
Hospital Revenue Code	430
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
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	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.73
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.59

OT MODALITY ELEC STIM UNATTEND

Facility

$91.25

Service Code	HCPCS G0283GO
Hospital Charge Code	9100175
Hospital Revenue Code	430
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

OT NEUROMUSCULAR RE-EDUCATION

Facility

$128.00

Service Code	HCPCS 97112GO
Hospital Charge Code	9100180
Hospital Revenue Code	430
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
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	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.64

OT NEUROMUSCULAR RE-EDUCATION

Facility

$128.00

Service Code	HCPCS 97112GO
Hospital Charge Code	9100180
Hospital Revenue Code	430
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

OTOLOGICAL DRAIN TUBE 1.0 MM

Facility

$248.00

Hospital Charge Code	270331530
Hospital Revenue Code	278
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$94.24
Rate for Payer: Aetna Medicare Advantage	$74.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.24
Rate for Payer: Cigna Commercial	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.02
Rate for Payer: Qualcare PPO/HMO/WC	$37.20
Rate for Payer: UnitedHealthcare Community & State	$7.84
Rate for Payer: Wellpoint Medicaid Managed Care	$7.04

OTOLOGICAL DRAIN TUBE 1.0 MM

Facility

$248.00

Hospital Charge Code	270331530
Hospital Revenue Code	278
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.02
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

OT ORTHOT MNG/TRAIN 15MIN 1ST

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008365
Hospital Revenue Code	430
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$71.82
Rate for Payer: Aetna Medicare Advantage	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.20
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	$48.20
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.14
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.97
Rate for Payer: Wellpoint Medicaid Managed Care	$5.37

OT ORTHOT MNG/TRAIN 15MIN 1ST

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008365
Hospital Revenue Code	430
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

OT ORTHOT MNG/TRAIN EA 15M 1ST

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	74203075
Hospital Revenue Code	430
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OT ORTHOT MNG/TRAIN EA 15M 1ST

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	74203075
Hospital Revenue Code	430
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
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	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.96
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$14.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

OT PARAFFIN BATH

Facility

$266.00

Service Code	HCPCS 97018GO
Hospital Charge Code	74203031
Hospital Revenue Code	430
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$101.08
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.16
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.55

OT PARAFFIN BATH

Facility

$266.00

Service Code	HCPCS 97018GO
Hospital Charge Code	74203031
Hospital Revenue Code	430
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

OT PHYS PERF TEST 15MIN

Facility

$218.00

Service Code	HCPCS 97750GO
Hospital Charge Code	74203073
Hospital Revenue Code	430
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$82.84
Rate for Payer: Aetna Medicare Advantage	$65.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.59
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	$55.59
Rate for Payer: Cigna Commercial	$109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.68
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$6.19

OT PHYS PERF TEST 15MIN

Facility

$218.00

Service Code	HCPCS 97750GO
Hospital Charge Code	74203073
Hospital Revenue Code	430
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$32.70

OT RE-EVALUATION

Facility

$2,400.00

Service Code	HCPCS 97168GO
Hospital Charge Code	74203128
Hospital Revenue Code	434
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OT RE-EVALUATION

Facility

$2,400.00

Service Code	HCPCS 97168GO
Hospital Charge Code	74203128
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 REEVALUATION

Facility

$167.25

Service Code	HCPCS 97004GO
Hospital Charge Code	9001020
Hospital Revenue Code	434
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$63.55
Rate for Payer: Aetna Medicare Advantage	$50.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.65
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	$42.65
Rate for Payer: Cigna Commercial	$83.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.48
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: Wellpoint Medicaid Managed Care	$65.00

OT REEVALUATION

Facility

$167.25

Service Code	HCPCS 97004GO
Hospital Charge Code	9001020
Hospital Revenue Code	434
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

OT ROM STRENGTHENIN 15MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	74203043
Hospital Revenue Code	430
Min. Negotiated Rate	$12.33
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$164.92
Rate for Payer: Aetna Medicare Advantage	$130.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.67
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	$110.67
Rate for Payer: Cigna Commercial	$217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.84
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$13.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.33

Know your out-of-pocket cost for care.

All Charges