Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$9,320.88

Service Code	APR-DRG 2442
Min. Negotiated Rate	$9,138.12
Max. Negotiated Rate	$9,320.88
Rate for Payer: UnitedHealthcare Community & State	$9,138.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,320.88
Rate for Payer: Wellpoint Medicaid Managed Care	$9,138.12

DIVICE FIXATION SECURESTRAP ST

Facility

$2,731.37

Hospital Charge Code	270655644
Hospital Revenue Code	272
Min. Negotiated Rate	$77.57
Max. Negotiated Rate	$1,365.68
Rate for Payer: Aetna Commercial	$1,037.92
Rate for Payer: Aetna Medicare Advantage	$819.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$696.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$696.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$696.50
Rate for Payer: Cigna Commercial	$1,365.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$710.16
Rate for Payer: Oxford Commercial	$546.27
Rate for Payer: Qualcare PPO/HMO/WC	$409.71
Rate for Payer: UnitedHealthcare Commercial	$546.27
Rate for Payer: UnitedHealthcare Community & State	$86.31
Rate for Payer: Wellpoint Medicaid Managed Care	$77.57

DIVICE FIXATION SECURESTRAP ST

Facility

$2,731.37

Hospital Charge Code	270655644
Hospital Revenue Code	272
Min. Negotiated Rate	$409.71
Max. Negotiated Rate	$409.71
Rate for Payer: Qualcare PPO/HMO/WC	$409.71

D-LACTATE,PLASMA

Facility

$634.60

Service Code	HCPCS 83605
Hospital Charge Code	3001740
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$317.30
Rate for Payer: Aetna Commercial	$31.47
Rate for Payer: Aetna Medicare Advantage	$37.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.97
Rate for Payer: Cigna Commercial	$317.30
Rate for Payer: Cigna Medicare Advantage	$11.57
Rate for Payer: Clover Medicare Advantage	$10.99
Rate for Payer: EmblemHealth Commercial	$34.71
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.19
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.57
Rate for Payer: Wellcare Medicare Advantage	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$18.02

D-LACTATE,PLASMA

Facility

$634.60

Service Code	HCPCS 83605
Hospital Charge Code	3001740
Hospital Revenue Code	301
Min. Negotiated Rate	$95.19
Max. Negotiated Rate	$95.19
Rate for Payer: Qualcare PPO/HMO/WC	$95.19

DLU ENDO GIA 30 3.5 30807L

Facility

$497.48

Hospital Charge Code	270600121
Hospital Revenue Code	270
Min. Negotiated Rate	$14.13
Max. Negotiated Rate	$248.74
Rate for Payer: Aetna Commercial	$189.04
Rate for Payer: Aetna Medicare Advantage	$149.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.86
Rate for Payer: Cigna Commercial	$248.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.34
Rate for Payer: Oxford Commercial	$99.50
Rate for Payer: Qualcare PPO/HMO/WC	$74.62
Rate for Payer: UnitedHealthcare Commercial	$99.50
Rate for Payer: UnitedHealthcare Community & State	$15.72
Rate for Payer: Wellpoint Medicaid Managed Care	$14.13

DLU ENDO GIA 30 3.5 30807L

Facility

$497.48

Hospital Charge Code	270600121
Hospital Revenue Code	270
Min. Negotiated Rate	$74.62
Max. Negotiated Rate	$74.62
Rate for Payer: Qualcare PPO/HMO/WC	$74.62

DLU ENDO GIA II 30 3.5 030419

Facility

$439.47

Hospital Charge Code	270608864
Hospital Revenue Code	272
Min. Negotiated Rate	$65.92
Max. Negotiated Rate	$65.92
Rate for Payer: Qualcare PPO/HMO/WC	$65.92

DLU ENDO GIA II 30 3.5 030419

Facility

$439.47

Hospital Charge Code	270608864
Hospital Revenue Code	272
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$219.74
Rate for Payer: Aetna Commercial	$167.00
Rate for Payer: Aetna Medicare Advantage	$131.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.06
Rate for Payer: Cigna Commercial	$219.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.26
Rate for Payer: Oxford Commercial	$87.89
Rate for Payer: Qualcare PPO/HMO/WC	$65.92
Rate for Payer: UnitedHealthcare Commercial	$87.89
Rate for Payer: UnitedHealthcare Community & State	$13.89
Rate for Payer: Wellpoint Medicaid Managed Care	$12.48

DLU ENDO GIA II 45 2.5 030425

Facility

$439.47

Hospital Charge Code	270608865
Hospital Revenue Code	272
Min. Negotiated Rate	$65.92
Max. Negotiated Rate	$65.92
Rate for Payer: Qualcare PPO/HMO/WC	$65.92

DLU ENDO GIA II 45 2.5 030425

Facility

$439.47

Hospital Charge Code	270608865
Hospital Revenue Code	272
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$219.74
Rate for Payer: Aetna Commercial	$167.00
Rate for Payer: Aetna Medicare Advantage	$131.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.06
Rate for Payer: Cigna Commercial	$219.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.26
Rate for Payer: Oxford Commercial	$87.89
Rate for Payer: Qualcare PPO/HMO/WC	$65.92
Rate for Payer: UnitedHealthcare Commercial	$87.89
Rate for Payer: UnitedHealthcare Community & State	$13.89
Rate for Payer: Wellpoint Medicaid Managed Care	$12.48

DLU ENDO GIA II 60 3.5 030414

Facility

$665.58

Hospital Charge Code	270608869
Hospital Revenue Code	272
Min. Negotiated Rate	$99.84
Max. Negotiated Rate	$99.84
Rate for Payer: Qualcare PPO/HMO/WC	$99.84

DLU ENDO GIA II 60 3.5 030414

Facility

$665.58

Hospital Charge Code	270608869
Hospital Revenue Code	272
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$332.79
Rate for Payer: Aetna Commercial	$252.92
Rate for Payer: Aetna Medicare Advantage	$199.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.72
Rate for Payer: Cigna Commercial	$332.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.05
Rate for Payer: Oxford Commercial	$133.12
Rate for Payer: Qualcare PPO/HMO/WC	$99.84
Rate for Payer: UnitedHealthcare Commercial	$133.12
Rate for Payer: UnitedHealthcare Community & State	$21.03
Rate for Payer: Wellpoint Medicaid Managed Care	$18.90

DLU ENDO GIA II 60 4.8 030415

Facility

$659.13

Hospital Charge Code	270608870
Hospital Revenue Code	272
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$329.56
Rate for Payer: Aetna Commercial	$250.47
Rate for Payer: Aetna Medicare Advantage	$197.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.08
Rate for Payer: Cigna Commercial	$329.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.37
Rate for Payer: Oxford Commercial	$131.83
Rate for Payer: Qualcare PPO/HMO/WC	$98.87
Rate for Payer: UnitedHealthcare Commercial	$131.83
Rate for Payer: UnitedHealthcare Community & State	$20.83
Rate for Payer: Wellpoint Medicaid Managed Care	$18.72

DLU ENDO GIA II 60 4.8 030415

Facility

$659.13

Hospital Charge Code	270608870
Hospital Revenue Code	272
Min. Negotiated Rate	$98.87
Max. Negotiated Rate	$98.87
Rate for Payer: Qualcare PPO/HMO/WC	$98.87

DLYD PLMT XTN PROSTH 1ST VSL

Facility

$13,570.00

Service Code	HCPCS 34710
Hospital Charge Code	2004960
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

DLYD PLMT XTN PROSTH 1ST VSL

Facility

$13,570.00

Service Code	HCPCS 34710
Hospital Charge Code	2004960
Hospital Revenue Code	361
Min. Negotiated Rate	$385.39
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,528.20
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$428.81
Rate for Payer: Wellpoint Medicaid Managed Care	$385.39

DLYD PLMT XTN PROSTH 1ST VSL

Facility

$13,570.00

Service Code	HCPCS 34710
Hospital Charge Code	321034710
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

DLYD PLMT XTN PROSTH 1ST VSL

Facility

$13,570.00

Service Code	HCPCS 34710
Hospital Charge Code	321034710
Hospital Revenue Code	361
Min. Negotiated Rate	$385.39
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,528.20
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$428.81
Rate for Payer: Wellpoint Medicaid Managed Care	$385.39

DLYD PLMT XTN PROSTH EA ADDL

Facility

$13,570.00

Service Code	HCPCS 34711
Hospital Charge Code	321034711
Hospital Revenue Code	361
Min. Negotiated Rate	$385.39
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,528.20
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$428.81
Rate for Payer: Wellpoint Medicaid Managed Care	$385.39

DLYD PLMT XTN PROSTH EA ADDL

Facility

$13,570.00

Service Code	HCPCS 34711
Hospital Charge Code	321034711
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

DLYD PLMT XTN PROSTH EA ADDL

Facility

$13,570.00

Service Code	HCPCS 34711
Hospital Charge Code	2004961
Hospital Revenue Code	361
Min. Negotiated Rate	$385.39
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,528.20
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$428.81
Rate for Payer: Wellpoint Medicaid Managed Care	$385.39

DLYD PLMT XTN PROSTH EA ADDL

Facility

$13,570.00

Service Code	HCPCS 34711
Hospital Charge Code	2004961
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

DLY INS BREAST PROSTH S/P M

Facility

$57,566.30

Service Code	HCPCS 19342
Hospital Charge Code	16000466
Hospital Revenue Code	360
Min. Negotiated Rate	$8,634.94
Max. Negotiated Rate	$8,634.94
Rate for Payer: Qualcare PPO/HMO/WC	$8,634.94

DLY INS BREAST PROSTH S/P M

Facility

$57,566.30

Service Code	HCPCS 19342
Hospital Charge Code	16000466
Hospital Revenue Code	360
Min. Negotiated Rate	$1,634.88
Max. Negotiated Rate	$35,223.75
Rate for Payer: Aetna Commercial	$26,411.74
Rate for Payer: Aetna Medicare Advantage	$31,461.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,223.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,223.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,710.20
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	$35,223.75
Rate for Payer: Cigna Commercial	$19,464.07
Rate for Payer: Cigna Medicare Advantage	$9,710.20
Rate for Payer: Clover Medicare Advantage	$9,224.69
Rate for Payer: EmblemHealth Commercial	$29,130.60
Rate for Payer: Humana Medicare Advantage	$10,001.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,710.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,967.24
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,634.94
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,819.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,710.20
Rate for Payer: Wellcare Medicare Advantage	$9,710.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1,634.88

Know your out-of-pocket cost for care.

All Charges