Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

THERAPEUTIC ACT EA 15 MIN CQ

Facility

$244.50

Service Code	HCPCS 97530GP
Hospital Charge Code	409197530Q
Hospital Revenue Code	420
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$92.91
Rate for Payer: Aetna Medicare Advantage	$73.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.35
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	$62.35
Rate for Payer: Cigna Commercial	$122.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.57
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.67
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.73
Rate for Payer: Wellpoint Medicaid Managed Care	$6.94

THERAPEUTIC ACTIVITY 15 MIN

Facility

$245.00

Service Code	HCPCS 97530GO
Hospital Charge Code	1008290
Hospital Revenue Code	430
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
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	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.70
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.74
Rate for Payer: Wellpoint Medicaid Managed Care	$6.96

THERAPEUTIC ACTIVITY 15 MIN

Facility

$245.00

Service Code	HCPCS 97530GP
Hospital Charge Code	1008300
Hospital Revenue Code	420
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

THERAPEUTIC ACTIVITY 15 MIN

Facility

$245.00

Service Code	HCPCS 97530GP
Hospital Charge Code	1008300
Hospital Revenue Code	420
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
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	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.70
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.74
Rate for Payer: Wellpoint Medicaid Managed Care	$6.96

THERAPEUTIC ACTIVITY 15 MIN

Facility

$245.00

Service Code	HCPCS 97530GO
Hospital Charge Code	1008290
Hospital Revenue Code	430
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

THERAPEUTIC BOTOX

Facility

$2,705.00

Hospital Charge Code	270666212
Hospital Revenue Code	636
Min. Negotiated Rate	$405.75
Max. Negotiated Rate	$654.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.61
Rate for Payer: Qualcare PPO/HMO/WC	$405.75

THERAPEUTIC BOTOX

Facility

$2,705.00

Hospital Charge Code	270666212
Hospital Revenue Code	636
Min. Negotiated Rate	$76.82
Max. Negotiated Rate	$1,352.50
Rate for Payer: Aetna Commercial	$1,027.90
Rate for Payer: Aetna Medicare Advantage	$811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$689.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$689.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$689.77
Rate for Payer: Cigna Commercial	$1,352.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.61
Rate for Payer: Qualcare PPO/HMO/WC	$405.75
Rate for Payer: UnitedHealthcare Community & State	$85.48
Rate for Payer: Wellpoint Medicaid Managed Care	$76.82

THERAPEUTIC EX EA 15 MIN CQ

Facility

$223.95

Service Code	HCPCS 97110GP
Hospital Charge Code	409197110Q
Hospital Revenue Code	420
Min. Negotiated Rate	$33.59
Max. Negotiated Rate	$33.59
Rate for Payer: Qualcare PPO/HMO/WC	$33.59

THERAPEUTIC EX EA 15 MIN CQ

Facility

$223.95

Service Code	HCPCS 97110GP
Hospital Charge Code	409197110Q
Hospital Revenue Code	420
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

THERAPEUTIC GROUP CQ

Facility

$103.25

Service Code	HCPCS 97150GP
Hospital Charge Code	409197150Q
Hospital Revenue Code	420
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$39.23
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.33
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	$26.33
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.84
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

THERAPEUTIC GROUP CQ

Facility

$103.25

Service Code	HCPCS 97150GP
Hospital Charge Code	409197150Q
Hospital Revenue Code	420
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

THERAPEUTIC PHLEBOTOMY

Facility

$712.00

Service Code	HCPCS 99195
Hospital Charge Code	3400090
Hospital Revenue Code	940
Min. Negotiated Rate	$20.22
Max. Negotiated Rate	$2,377.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.12
Rate for Payer: Oxford Commercial	$2,054.00
Rate for Payer: Qualcare PPO/HMO/WC	$106.80
Rate for Payer: UnitedHealthcare Commercial	$2,377.00
Rate for Payer: UnitedHealthcare Community & State	$22.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$20.22

THERAPEUTIC PHLEBOTOMY

Facility

$264.80

Service Code	HCPCS 99195
Hospital Charge Code	93500101
Hospital Revenue Code	940
Min. Negotiated Rate	$39.72
Max. Negotiated Rate	$39.72
Rate for Payer: Qualcare PPO/HMO/WC	$39.72

THERAPEUTIC PHLEBOTOMY

Facility

$264.80

Service Code	HCPCS 99195
Hospital Charge Code	93500101
Hospital Revenue Code	940
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$2,377.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.85
Rate for Payer: Oxford Commercial	$2,054.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.72
Rate for Payer: UnitedHealthcare Commercial	$2,377.00
Rate for Payer: UnitedHealthcare Community & State	$8.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.52

THERAPEUTIC PHLEBOTOMY

Facility

$712.00

Service Code	HCPCS 99195
Hospital Charge Code	3400090
Hospital Revenue Code	940
Min. Negotiated Rate	$106.80
Max. Negotiated Rate	$106.80
Rate for Payer: Qualcare PPO/HMO/WC	$106.80

THERAPEUTIC PILPOTOMY

Facility

$9,790.05

Service Code	HCPCS D3220
Hospital Charge Code	1600000744
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.51
Max. Negotiated Rate	$1,468.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51

THERAPEUTIC PILPOTOMY

Facility

$9,790.05

Service Code	HCPCS D3220
Hospital Charge Code	1600000744
Hospital Revenue Code	360
Min. Negotiated Rate	$278.04
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,089.07
Rate for Payer: Aetna Medicare Advantage	$2,488.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,786.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,786.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$768.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,786.07
Rate for Payer: Cigna Commercial	$1,539.55
Rate for Payer: Cigna Medicare Advantage	$768.04
Rate for Payer: Clover Medicare Advantage	$729.64
Rate for Payer: EmblemHealth Commercial	$2,304.12
Rate for Payer: Humana Medicare Advantage	$791.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$768.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,545.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,468.51
Rate for Payer: UnitedHealthcare Community & State	$309.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$768.04
Rate for Payer: Wellcare Medicare Advantage	$768.04
Rate for Payer: Wellpoint Medicaid Managed Care	$278.04

THERAPY SESSION KIT

Facility

$50.00

Hospital Charge Code	270682400N
Hospital Revenue Code	272
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

THERAPY SESSION KIT

Facility

$50.00

Hospital Charge Code	270682400
Hospital Revenue Code	272
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

THERAPY SESSION KIT

Facility

$50.00

Hospital Charge Code	270682400N
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

THERAPY SESSION KIT

Facility

$50.00

Hospital Charge Code	270682400
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

THERASKIN BIOLOGICAL GRAFT

Facility

$3,975.00

Hospital Charge Code	270339528
Hospital Revenue Code	636
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

THERASKIN BIOLOGICAL GRAFT

Facility

$3,975.00

Hospital Charge Code	270339528
Hospital Revenue Code	636
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$125.61
Rate for Payer: Wellpoint Medicaid Managed Care	$112.89

THERASKIN LARGE 2X3IN 102TSL

Facility

$6,375.00

Service Code	HCPCS Q4121
Hospital Charge Code	270646972
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

THERASKIN LARGE 2X3IN 102TSL

Facility

$6,375.00

Service Code	HCPCS Q4121
Hospital Charge Code	270646972
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,542.75
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$201.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$181.05

Know your out-of-pocket cost for care.

All Charges