Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PHOTHERAPY/ACTINOTHERAPY

Facility

$136.00

Service Code	HCPCS 96900
Hospital Charge Code	83080045
Hospital Revenue Code	940
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$20.40
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

PHOTHERAPY/ACTINOTHERAPY

Facility

$136.00

Service Code	HCPCS 96900
Hospital Charge Code	83090020
Hospital Revenue Code	940
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$2,377.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.36
Rate for Payer: Oxford Commercial	$2,054.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.40
Rate for Payer: UnitedHealthcare Commercial	$2,377.00
Rate for Payer: UnitedHealthcare Community & State	$4.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

PHOTHERAPY/ACTINOTHERAPY

Facility

$136.00

Service Code	HCPCS 96900
Hospital Charge Code	83092030
Hospital Revenue Code	940
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$2,377.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.36
Rate for Payer: Oxford Commercial	$2,054.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.40
Rate for Payer: UnitedHealthcare Commercial	$2,377.00
Rate for Payer: UnitedHealthcare Community & State	$4.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

PHOTHERAPY/ACTINOTHERAPY

Facility

$136.00

Service Code	HCPCS 96900
Hospital Charge Code	83080045
Hospital Revenue Code	940
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$2,377.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.36
Rate for Payer: Oxford Commercial	$2,054.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.40
Rate for Payer: UnitedHealthcare Commercial	$2,377.00
Rate for Payer: UnitedHealthcare Community & State	$4.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

PHOTHERAPY/ACTINOTHERAPY

Facility

$136.00

Service Code	HCPCS 96900
Hospital Charge Code	83090020
Hospital Revenue Code	940
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$20.40
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

PHOTHERAPY/ACTINOTHERAPY

Facility

$136.00

Service Code	HCPCS 96900
Hospital Charge Code	83092030
Hospital Revenue Code	940
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$20.40
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

PHOTOBBLADE 3

Facility

$1,600.00

Hospital Charge Code	270703813
Hospital Revenue Code	272
Min. Negotiated Rate	$45.44
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$608.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$416.00
Rate for Payer: Oxford Commercial	$320.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Commercial	$320.00
Rate for Payer: UnitedHealthcare Community & State	$50.56
Rate for Payer: Wellpoint Medicaid Managed Care	$45.44

PHOTOBBLADE 3

Facility

$1,600.00

Hospital Charge Code	270703813
Hospital Revenue Code	272
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

PHP Activity Therapy/session

Facility

$165.80

Service Code	HCPCS G0176
Hospital Charge Code	84509055
Hospital Revenue Code	904
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$24.87
Rate for Payer: Qualcare PPO/HMO/WC	$24.87

PHP Activity Therapy/session

Facility

$165.80

Service Code	HCPCS G0176
Hospital Charge Code	84509055
Hospital Revenue Code	904
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$82.90
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: Aetna Medicare Advantage	$49.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.28
Rate for Payer: Cigna Commercial	$82.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.11
Rate for Payer: Qualcare PPO/HMO/WC	$24.87
Rate for Payer: UnitedHealthcare Community & State	$5.24
Rate for Payer: Wellpoint Medicaid Managed Care	$4.71

PHP ACTIVITY TX/SESSION ADULT

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4509527
Hospital Revenue Code	904
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

PHP ACTIVITY TX/SESSION ADULT

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4509527
Hospital Revenue Code	904
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

PHP ACTIVITY TX/SESSION CHILD

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4509528
Hospital Revenue Code	904
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

PHP ACTIVITY TX/SESSION CHILD

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4510528
Hospital Revenue Code	904
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

PHP ACTIVITY TX/SESSION CHILD

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4509528
Hospital Revenue Code	904
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

PHP ACTIVITY TX/SESSION CHILD

Facility

$375.00

Service Code	HCPCS G0176
Hospital Charge Code	4510528
Hospital Revenue Code	904
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

PHP Education/Training

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	84509051
Hospital Revenue Code	942
Min. Negotiated Rate	$76.68
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

PHP Education/Training

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	84509051
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

PHP EDUCATION/TRAINING ADULT

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	4509529
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

PHP EDUCATION/TRAINING ADULT

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	4509529
Hospital Revenue Code	942
Min. Negotiated Rate	$76.68
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

PHP EDUCATION/TRAINING CHILD

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	4509530
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

PHP EDUCATION/TRAINING CHILD

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	4509530
Hospital Revenue Code	942
Min. Negotiated Rate	$76.68
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

PHP EDUCATION/TRAINING CHILD

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	4510530
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

PHP EDUCATION/TRAINING CHILD

Facility

$2,700.00

Service Code	HCPCS G0177
Hospital Charge Code	4510530
Hospital Revenue Code	942
Min. Negotiated Rate	$76.68
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

PHP Group 45-50 min

Facility

$800.80

Service Code	HCPCS G0410
Hospital Charge Code	84509053
Hospital Revenue Code	915
Min. Negotiated Rate	$22.74
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.21
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$25.31
Rate for Payer: Wellpoint Medicaid Managed Care	$22.74

Know your out-of-pocket cost for care.

All Charges