Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL COMP PSA #4 LEFT

Facility

$21,270.00

Service Code	HCPCS C1776
Hospital Charge Code	270676874
Hospital Revenue Code	278
Min. Negotiated Rate	$604.07
Max. Negotiated Rate	$10,635.00
Rate for Payer: Aetna Commercial	$8,082.60
Rate for Payer: Aetna Medicare Advantage	$6,381.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,423.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,423.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,423.85
Rate for Payer: Cigna Commercial	$10,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.50
Rate for Payer: UnitedHealthcare Community & State	$672.13
Rate for Payer: Wellpoint Medicaid Managed Care	$604.07

FEMORAL COMP PSA #4 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676961
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 PSA #4 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676961
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 SIZE 4 RIGHT

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680693
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

FEMORAL COMP SIZE 4 RIGHT

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680693
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

FEMORAL COMP SZ 1/1 A/P 53MM

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670039
Hospital Revenue Code	278
Min. Negotiated Rate	$3,190.72
Max. Negotiated Rate	$5,147.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72

FEMORAL COMP SZ 1/1 A/P 53MM

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670039
Hospital Revenue Code	278
Min. Negotiated Rate	$604.11
Max. Negotiated Rate	$10,635.75
Rate for Payer: Aetna Commercial	$8,083.17
Rate for Payer: Aetna Medicare Advantage	$6,381.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,424.23
Rate for Payer: Cigna Commercial	$10,635.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72
Rate for Payer: UnitedHealthcare Community & State	$672.18
Rate for Payer: Wellpoint Medicaid Managed Care	$604.11

FEMORAL COMP SZ2 8MM M/L 60MM

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670550
Hospital Revenue Code	278
Min. Negotiated Rate	$3,190.72
Max. Negotiated Rate	$5,147.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72

FEMORAL COMP SZ2 8MM M/L 60MM

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670550
Hospital Revenue Code	278
Min. Negotiated Rate	$604.11
Max. Negotiated Rate	$10,635.75
Rate for Payer: Aetna Commercial	$8,083.17
Rate for Payer: Aetna Medicare Advantage	$6,381.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,424.23
Rate for Payer: Cigna Commercial	$10,635.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72
Rate for Payer: UnitedHealthcare Community & State	$672.18
Rate for Payer: Wellpoint Medicaid Managed Care	$604.11

FEMORAL COMP SZ3 A/P 76 M/L 70

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670650
Hospital Revenue Code	278
Min. Negotiated Rate	$604.11
Max. Negotiated Rate	$10,635.75
Rate for Payer: Aetna Commercial	$8,083.17
Rate for Payer: Aetna Medicare Advantage	$6,381.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,424.23
Rate for Payer: Cigna Commercial	$10,635.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72
Rate for Payer: UnitedHealthcare Community & State	$672.18
Rate for Payer: Wellpoint Medicaid Managed Care	$604.11

FEMORAL COMP SZ3 A/P 76 M/L 70

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670650
Hospital Revenue Code	278
Min. Negotiated Rate	$3,190.72
Max. Negotiated Rate	$5,147.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72

FEMORAL COMP SZ5 A/P 72 M/L 75

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270676682
Hospital Revenue Code	278
Min. Negotiated Rate	$3,190.72
Max. Negotiated Rate	$5,147.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72

FEMORAL COMP SZ5 A/P 72 M/L 75

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270676682
Hospital Revenue Code	278
Min. Negotiated Rate	$604.11
Max. Negotiated Rate	$10,635.75
Rate for Payer: Aetna Commercial	$8,083.17
Rate for Payer: Aetna Medicare Advantage	$6,381.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,424.23
Rate for Payer: Cigna Commercial	$10,635.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72
Rate for Payer: UnitedHealthcare Community & State	$672.18
Rate for Payer: Wellpoint Medicaid Managed Care	$604.11

FEMORAL COMP TRIATHLON PS RT5

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270691997
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.68
Max. Negotiated Rate	$1,751.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68

FEMORAL COMP TRIATHLON PS RT5

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270691997
Hospital Revenue Code	278
Min. Negotiated Rate	$205.56
Max. Negotiated Rate	$3,618.95
Rate for Payer: Aetna Commercial	$2,750.40
Rate for Payer: Aetna Medicare Advantage	$2,171.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.66
Rate for Payer: Cigna Commercial	$3,618.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68
Rate for Payer: UnitedHealthcare Community & State	$228.72
Rate for Payer: Wellpoint Medicaid Managed Care	$205.56

FEMORAL CONDYLE HEMI RIGHT

Facility

$59,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270679139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,683.13
Max. Negotiated Rate	$29,632.50
Rate for Payer: Aetna Commercial	$22,520.70
Rate for Payer: Aetna Medicare Advantage	$17,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,112.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,112.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,112.58
Rate for Payer: Cigna Commercial	$29,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,342.13
Rate for Payer: Qualcare PPO/HMO/WC	$8,889.75
Rate for Payer: UnitedHealthcare Community & State	$1,872.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1,683.13

FEMORAL CONDYLE HEMI RIGHT

Facility

$59,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270679139
Hospital Revenue Code	278
Min. Negotiated Rate	$8,889.75
Max. Negotiated Rate	$14,342.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,342.13
Rate for Payer: Qualcare PPO/HMO/WC	$8,889.75

FEMORAL CONDYLE LEFT

Facility

$58,350.00

Service Code	HCPCS C1776
Hospital Charge Code	270684836
Hospital Revenue Code	278
Min. Negotiated Rate	$8,752.50
Max. Negotiated Rate	$14,120.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,120.70
Rate for Payer: Qualcare PPO/HMO/WC	$8,752.50

FEMORAL CONDYLE LEFT

Facility

$58,350.00

Service Code	HCPCS C1776
Hospital Charge Code	270684836
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.14
Max. Negotiated Rate	$29,175.00
Rate for Payer: Aetna Commercial	$22,173.00
Rate for Payer: Aetna Medicare Advantage	$17,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,879.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,879.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,879.25
Rate for Payer: Cigna Commercial	$29,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,120.70
Rate for Payer: Qualcare PPO/HMO/WC	$8,752.50
Rate for Payer: UnitedHealthcare Community & State	$1,843.86
Rate for Payer: Wellpoint Medicaid Managed Care	$1,657.14

FEMORAL CRUCIATE #4 LFL

Facility

$7,097.05

Service Code	HCPCS C1776
Hospital Charge Code	270691042
Hospital Revenue Code	278
Min. Negotiated Rate	$201.56
Max. Negotiated Rate	$3,548.53
Rate for Payer: Aetna Commercial	$2,696.88
Rate for Payer: Aetna Medicare Advantage	$2,129.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,809.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,809.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,809.75
Rate for Payer: Cigna Commercial	$3,548.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,717.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.56
Rate for Payer: UnitedHealthcare Community & State	$224.27
Rate for Payer: Wellpoint Medicaid Managed Care	$201.56

FEMORAL CRUCIATE #4 LFL

Facility

$7,097.05

Service Code	HCPCS C1776
Hospital Charge Code	270691042
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.56
Max. Negotiated Rate	$1,717.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,717.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.56

FEMORAL CRUCIATE RT CR SZ3

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	693337
Hospital Revenue Code	278
Min. Negotiated Rate	$299.04
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$332.73
Rate for Payer: Wellpoint Medicaid Managed Care	$299.04

FEMORAL CRUCIATE RT CR SZ3

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	693337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

FEMORAL CRUCIATE SZ 5

Facility

$7,846.70

Service Code	HCPCS C1776
Hospital Charge Code	270691406
Hospital Revenue Code	278
Min. Negotiated Rate	$1,177.01
Max. Negotiated Rate	$1,898.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.01

FEMORAL CRUCIATE SZ 5

Facility

$7,846.70

Service Code	HCPCS C1776
Hospital Charge Code	270691406
Hospital Revenue Code	278
Min. Negotiated Rate	$222.85
Max. Negotiated Rate	$3,923.35
Rate for Payer: Aetna Commercial	$2,981.75
Rate for Payer: Aetna Medicare Advantage	$2,354.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.91
Rate for Payer: Cigna Commercial	$3,923.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.01
Rate for Payer: UnitedHealthcare Community & State	$247.96
Rate for Payer: Wellpoint Medicaid Managed Care	$222.85

Know your out-of-pocket cost for care.

All Charges