Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OT THERA PROCEDURES GROUP

Facility

$103.00

Service Code	HCPCS 97150GO
Hospital Charge Code	74203055
Hospital Revenue Code	430
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

OT THERA PROCEDURES GROUP

Facility

$103.00

Service Code	HCPCS 97150GO
Hospital Charge Code	74203055
Hospital Revenue Code	430
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
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	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.78
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

OT THERAPY EXERCISE EA 15 MIN

Facility

$223.95

Service Code	HCPCS 97110GO
Hospital Charge Code	9000332
Hospital Revenue Code	430
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$85.10
Rate for Payer: Aetna Medicare Advantage	$67.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.11
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	$57.11
Rate for Payer: Cigna Commercial	$111.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.23
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.59
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.08
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

OT THERAPY EXERCISE EA 15 MIN

Facility

$223.95

Service Code	HCPCS 97110GO
Hospital Charge Code	9000332
Hospital Revenue Code	430
Min. Negotiated Rate	$33.59
Max. Negotiated Rate	$33.59
Rate for Payer: Qualcare PPO/HMO/WC	$33.59

OT:THER EXERCISE/TRAIN 15 MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	1008215
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

OT:THER EXERCISE/TRAIN 15 MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	1008215
Hospital Revenue Code	430
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

OT TNS

Facility

$77.65

Service Code	HCPCS 64550GO
Hospital Charge Code	9100048
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 TNS

Facility

$77.65

Service Code	HCPCS 64550GO
Hospital Charge Code	9100048
Hospital Revenue Code	430
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

OT ULTRASOUND ATTEN 15MIN

Facility

$314.00

Service Code	HCPCS 97035GO
Hospital Charge Code	74203041
Hospital Revenue Code	430
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

OT ULTRASOUND ATTEN 15MIN

Facility

$314.00

Service Code	HCPCS 97035GO
Hospital Charge Code	74203041
Hospital Revenue Code	430
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
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	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.64
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.92
Rate for Payer: Wellpoint Medicaid Managed Care	$8.92

OT ULTRASOUND EA 15 MIN

Facility

$65.65

Service Code	HCPCS 97035GO
Hospital Charge Code	9100058
Hospital Revenue Code	430
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
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	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.07
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.86

OT ULTRASOUND EA 15 MIN

Facility

$65.65

Service Code	HCPCS 97035GO
Hospital Charge Code	9100058
Hospital Revenue Code	430
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

OT VASOPNEUMATIC DEVICES

Facility

$214.00

Service Code	HCPCS 97016GO
Hospital Charge Code	74203029
Hospital Revenue Code	430
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$81.32
Rate for Payer: Aetna Medicare Advantage	$64.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.57
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	$54.57
Rate for Payer: Cigna Commercial	$107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.64
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$6.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.08

OT VASOPNEUMATIC DEVICES

Facility

$214.00

Service Code	HCPCS 97016GO
Hospital Charge Code	74203029
Hospital Revenue Code	430
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

OT WHEELCHAIR MGMT 15 MIN

Facility

$164.50

Service Code	HCPCS 97542GO
Hospital Charge Code	74203067
Hospital Revenue Code	430
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$24.68
Rate for Payer: Qualcare PPO/HMO/WC	$24.68

OT WHEELCHAIR MGMT 15 MIN

Facility

$164.50

Service Code	HCPCS 97542GO
Hospital Charge Code	74203067
Hospital Revenue Code	430
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$49.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.95
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	$41.95
Rate for Payer: Cigna Commercial	$82.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.77
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.68
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.20
Rate for Payer: Wellpoint Medicaid Managed Care	$4.67

OT WHIRLPOOL/FLUIDOTHERAP

Facility

$185.00

Service Code	HCPCS 97022GO
Hospital Charge Code	74203033
Hospital Revenue Code	430
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
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	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.10
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: Wellpoint Medicaid Managed Care	$5.25

OT WHIRLPOOL/FLUIDOTHERAP

Facility

$185.00

Service Code	HCPCS 97022GO
Hospital Charge Code	74203033
Hospital Revenue Code	430
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

OT WORK HARD COND ADD HRS

Facility

$170.00

Service Code	HCPCS 97546GO
Hospital Charge Code	74203071
Hospital Revenue Code	430
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

OT WORK HARD COND ADD HRS

Facility

$170.00

Service Code	HCPCS 97546GO
Hospital Charge Code	74203071
Hospital Revenue Code	430
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
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	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.20
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.83

OT WORK HARD CONDITIO 2HR

Facility

$601.00

Service Code	HCPCS 97545GO
Hospital Charge Code	74203069
Hospital Revenue Code	430
Min. Negotiated Rate	$17.07
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$228.38
Rate for Payer: Aetna Medicare Advantage	$180.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.25
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	$153.25
Rate for Payer: Cigna Commercial	$300.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.26
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.15
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$18.99
Rate for Payer: Wellpoint Medicaid Managed Care	$17.07

OT WORK HARD CONDITIO 2HR

Facility

$601.00

Service Code	HCPCS 97545GO
Hospital Charge Code	74203069
Hospital Revenue Code	430
Min. Negotiated Rate	$90.15
Max. Negotiated Rate	$90.15
Rate for Payer: Qualcare PPO/HMO/WC	$90.15

OUTFLOW TUBING

Facility

$115.50

Hospital Charge Code	270662372
Hospital Revenue Code	270
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$17.32
Rate for Payer: Qualcare PPO/HMO/WC	$17.32

OUTFLOW TUBING

Facility

$115.50

Hospital Charge Code	270662372
Hospital Revenue Code	270
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$57.75
Rate for Payer: Aetna Commercial	$43.89
Rate for Payer: Aetna Medicare Advantage	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.45
Rate for Payer: Cigna Commercial	$57.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.03
Rate for Payer: Oxford Commercial	$23.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.32
Rate for Payer: UnitedHealthcare Commercial	$23.10
Rate for Payer: UnitedHealthcare Community & State	$3.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.28

OUTPATIENT ADULT AND CHILD

Facility

$665.20

Service Code	HCPCS 99213
Hospital Charge Code	485099216
Hospital Revenue Code	919
Min. Negotiated Rate	$99.78
Max. Negotiated Rate	$99.78
Rate for Payer: Qualcare PPO/HMO/WC	$99.78

Know your out-of-pocket cost for care.

All Charges