Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DELTA AMINOLEVULINIC ACID (DAL

Facility

$181.00

Service Code	HCPCS 82135
Hospital Charge Code	38472089
Hospital Revenue Code	301
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$27.15
Rate for Payer: Qualcare PPO/HMO/WC	$27.15

DELTA AMINOLEVULINIC ACID (DAL

Facility

$181.00

Service Code	HCPCS 82135
Hospital Charge Code	38472089
Hospital Revenue Code	301
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$44.74
Rate for Payer: Aetna Medicare Advantage	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$90.50
Rate for Payer: Cigna Medicare Advantage	$16.45
Rate for Payer: Clover Medicare Advantage	$15.63
Rate for Payer: EmblemHealth Commercial	$49.35
Rate for Payer: Humana Medicare Advantage	$16.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.06
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.45
Rate for Payer: Wellcare Medicare Advantage	$16.45
Rate for Payer: Wellpoint Medicaid Managed Care	$5.14

DELTA HEAD MEDIUM 36MM BIOLOX

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681266
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

DELTA HEAD MEDIUM 36MM BIOLOX

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681266
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

DELTA-LITE CASTING TAPE

Facility

$40.00

Hospital Charge Code	270331637
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

DELTA-LITE CASTING TAPE

Facility

$40.00

Hospital Charge Code	270331637
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

DELTA LITE CAST TAPE 4 X 4YD

Facility

$54.00

Hospital Charge Code	270331781
Hospital Revenue Code	272
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.04
Rate for Payer: Oxford Commercial	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$10.80
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

DELTA LITE CAST TAPE 4 X 4YD

Facility

$54.00

Hospital Charge Code	270331781
Hospital Revenue Code	272
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

DELTA-NET ORTHO STOCKINET

Facility

$252.00

Hospital Charge Code	270332238
Hospital Revenue Code	272
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$95.76
Rate for Payer: Aetna Medicare Advantage	$75.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.26
Rate for Payer: Cigna Commercial	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.52
Rate for Payer: Oxford Commercial	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$37.80
Rate for Payer: UnitedHealthcare Commercial	$50.40
Rate for Payer: UnitedHealthcare Community & State	$7.96
Rate for Payer: Wellpoint Medicaid Managed Care	$7.16

DELTA-NET ORTHO STOCKINET

Facility

$252.00

Hospital Charge Code	270332238
Hospital Revenue Code	272
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$37.80

DELTA-NET STOCKINET 2X25YD

Facility

$140.00

Hospital Charge Code	270332343
Hospital Revenue Code	272
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.40
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$28.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

DELTA-NET STOCKINET 2X25YD

Facility

$140.00

Hospital Charge Code	270332343
Hospital Revenue Code	272
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

DELTA V-40 CERAMIC HEAD 36/+2.

Facility

$14,330.00

Service Code	HCPCS C1776
Hospital Charge Code	270684554
Hospital Revenue Code	278
Min. Negotiated Rate	$2,149.50
Max. Negotiated Rate	$3,467.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,866.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,467.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,149.50

DELTA V-40 CERAMIC HEAD 36/+2.

Facility

$14,330.00

Service Code	HCPCS C1776
Hospital Charge Code	270684554
Hospital Revenue Code	278
Min. Negotiated Rate	$406.97
Max. Negotiated Rate	$7,165.00
Rate for Payer: Aetna Commercial	$5,445.40
Rate for Payer: Aetna Medicare Advantage	$4,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,654.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,654.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,866.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,654.15
Rate for Payer: Cigna Commercial	$7,165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,467.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,149.50
Rate for Payer: UnitedHealthcare Community & State	$452.83
Rate for Payer: Wellpoint Medicaid Managed Care	$406.97

DELTA XTND CMNTLS MTGLN HA CTD

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270686471
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,395.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

DELTA XTND CMNTLS MTGLN HA CTD

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270686471
Hospital Revenue Code	278
Min. Negotiated Rate	$281.16
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$3,762.00
Rate for Payer: Aetna Medicare Advantage	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,524.50
Rate for Payer: Cigna Commercial	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00
Rate for Payer: UnitedHealthcare Community & State	$312.84
Rate for Payer: Wellpoint Medicaid Managed Care	$281.16

DELTOID LIGAMENT RECON IMPLANT

Facility

$13,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270680815
Hospital Revenue Code	278
Min. Negotiated Rate	$396.61
Max. Negotiated Rate	$6,982.50
Rate for Payer: Aetna Commercial	$5,306.70
Rate for Payer: Aetna Medicare Advantage	$4,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,561.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,561.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,561.07
Rate for Payer: Cigna Commercial	$6,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,379.53
Rate for Payer: Qualcare PPO/HMO/WC	$2,094.75
Rate for Payer: UnitedHealthcare Community & State	$441.29
Rate for Payer: Wellpoint Medicaid Managed Care	$396.61

DELTOID LIGAMENT RECON IMPLANT

Facility

$13,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270680815
Hospital Revenue Code	278
Min. Negotiated Rate	$2,094.75
Max. Negotiated Rate	$3,379.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,793.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,379.53
Rate for Payer: Qualcare PPO/HMO/WC	$2,094.75

DEL TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	73190073
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

DEL TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	73190073
Hospital Revenue Code	402
Min. Negotiated Rate	$117.99
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

DEL TUBAL LIGATION

Facility

$17,601.15

Service Code	HCPCS 58611
Hospital Charge Code	73190013
Hospital Revenue Code	361
Min. Negotiated Rate	$499.87
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$6,688.44
Rate for Payer: Aetna Medicare Advantage	$5,280.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,488.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,488.29
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	$4,488.29
Rate for Payer: Cigna Commercial	$8,800.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,576.30
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,640.17
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$556.20
Rate for Payer: Wellpoint Medicaid Managed Care	$499.87

DEL TUBAL LIGATION

Facility

$17,601.15

Service Code	HCPCS 58611
Hospital Charge Code	73190013
Hospital Revenue Code	361
Min. Negotiated Rate	$2,640.17
Max. Negotiated Rate	$2,640.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,640.17

DEL US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	73190067
Hospital Revenue Code	402
Min. Negotiated Rate	$32.29
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

DEL US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	73190067
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

DEL VBAC

Facility

$10,100.00

Service Code	HCPCS 59612
Hospital Charge Code	73190047
Hospital Revenue Code	720
Min. Negotiated Rate	$286.84
Max. Negotiated Rate	$13,950.60
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$439.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,950.60
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,626.00
Rate for Payer: Oxford Commercial	$4,053.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$319.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$286.84

Know your out-of-pocket cost for care.

All Charges