Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL AUGMENT PSA #4 4MM

Facility

$3,604.00

Service Code	HCPCS C1776
Hospital Charge Code	270676877
Hospital Revenue Code	278
Min. Negotiated Rate	$102.35
Max. Negotiated Rate	$1,802.00
Rate for Payer: Aetna Commercial	$1,369.52
Rate for Payer: Aetna Medicare Advantage	$1,081.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$919.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$919.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$919.02
Rate for Payer: Cigna Commercial	$1,802.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$872.17
Rate for Payer: Qualcare PPO/HMO/WC	$540.60
Rate for Payer: UnitedHealthcare Community & State	$113.89
Rate for Payer: Wellpoint Medicaid Managed Care	$102.35

FEMORAL AUGMENT PSA #4 4MM

Facility

$3,604.00

Service Code	HCPCS C1776
Hospital Charge Code	270676877
Hospital Revenue Code	278
Min. Negotiated Rate	$540.60
Max. Negotiated Rate	$872.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$872.17
Rate for Payer: Qualcare PPO/HMO/WC	$540.60

FEMORAL AUGMENT PSA #4 8MM

Facility

$3,604.00

Service Code	HCPCS C1776
Hospital Charge Code	270676876
Hospital Revenue Code	278
Min. Negotiated Rate	$540.60
Max. Negotiated Rate	$872.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$872.17
Rate for Payer: Qualcare PPO/HMO/WC	$540.60

FEMORAL AUGMENT PSA #4 8MM

Facility

$3,604.00

Service Code	HCPCS C1776
Hospital Charge Code	270676876
Hospital Revenue Code	278
Min. Negotiated Rate	$102.35
Max. Negotiated Rate	$1,802.00
Rate for Payer: Aetna Commercial	$1,369.52
Rate for Payer: Aetna Medicare Advantage	$1,081.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$919.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$919.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$919.02
Rate for Payer: Cigna Commercial	$1,802.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$872.17
Rate for Payer: Qualcare PPO/HMO/WC	$540.60
Rate for Payer: UnitedHealthcare Community & State	$113.89
Rate for Payer: Wellpoint Medicaid Managed Care	$102.35

FEMORAL BONE CEMENT PREP KIT

Facility

$1,650.00

Hospital Charge Code	270691598
Hospital Revenue Code	272
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.00
Rate for Payer: Oxford Commercial	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Commercial	$330.00
Rate for Payer: UnitedHealthcare Community & State	$52.14
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

FEMORAL BONE CEMENT PREP KIT

Facility

$1,650.00

Hospital Charge Code	270691598
Hospital Revenue Code	272
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

FEMORAL BUSHINGS

Facility

$2,245.00

Service Code	HCPCS C1713
Hospital Charge Code	270638570
Hospital Revenue Code	278
Min. Negotiated Rate	$336.75
Max. Negotiated Rate	$543.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$449.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$543.29
Rate for Payer: Qualcare PPO/HMO/WC	$336.75

FEMORAL BUSHINGS

Facility

$2,245.00

Service Code	HCPCS C1713
Hospital Charge Code	270638570
Hospital Revenue Code	278
Min. Negotiated Rate	$63.76
Max. Negotiated Rate	$1,122.50
Rate for Payer: Aetna Commercial	$853.10
Rate for Payer: Aetna Medicare Advantage	$673.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$572.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$572.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$449.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$572.48
Rate for Payer: Cigna Commercial	$1,122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$543.29
Rate for Payer: Qualcare PPO/HMO/WC	$336.75
Rate for Payer: UnitedHealthcare Community & State	$70.94
Rate for Payer: Wellpoint Medicaid Managed Care	$63.76

FEMORAL CEMENTED OPTETRAK SZ 5

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673670
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

FEMORAL CEMENTED OPTETRAK SZ 5

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673670
Hospital Revenue Code	278
Min. Negotiated Rate	$163.30
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$181.70
Rate for Payer: Wellpoint Medicaid Managed Care	$163.30

FEMORAL CHECK POINT

Facility

$266.50

Service Code	HCPCS C1713
Hospital Charge Code	270690848
Hospital Revenue Code	278
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$101.27
Rate for Payer: Aetna Medicare Advantage	$79.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.96
Rate for Payer: Cigna Commercial	$133.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98
Rate for Payer: UnitedHealthcare Community & State	$8.42
Rate for Payer: Wellpoint Medicaid Managed Care	$7.57

FEMORAL CHECK POINT

Facility

$266.50

Service Code	HCPCS C1713
Hospital Charge Code	270690848
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$64.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

FEMORAL CHECKPOINT STERILE

Facility

$270.00

Hospital Charge Code	270668098
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

FEMORAL CHECKPOINT STERILE

Facility

$270.00

Hospital Charge Code	270668098
Hospital Revenue Code	272
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$54.00
Rate for Payer: UnitedHealthcare Community & State	$8.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.67

FEMORAL COMP #3 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676673
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

FEMORAL COMP #3 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676673
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #3 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676623
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #3 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676623
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

FEMORAL COMP #5 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676725
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #5 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676725
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

FEMORAL COMP #5 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676751
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

FEMORAL COMP #5 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676751
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP #6 RIGHT

Facility

$6,000.00

Hospital Charge Code	270677058
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

FEMORAL COMP #6 RIGHT

Facility

$6,000.00

Hospital Charge Code	270677058
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL COMP CEMENTED #4 LEFT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676676
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

Know your out-of-pocket cost for care.

All Charges