Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL DISTAL AUG #3 12MM

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687696
Hospital Revenue Code	278
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$1,468.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

FEMORAL DISTAL AUG #3 12MM

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687696
Hospital Revenue Code	278
Min. Negotiated Rate	$172.39
Max. Negotiated Rate	$3,035.00
Rate for Payer: Aetna Commercial	$2,306.60
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Community & State	$191.81
Rate for Payer: Wellpoint Medicaid Managed Care	$172.39

FEMORAL DISTAL BLK SCW SZ4 5MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270670654
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$934.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

FEMORAL DISTAL BLK SCW SZ4 5MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270670654
Hospital Revenue Code	278
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$1,930.50
Rate for Payer: Aetna Commercial	$1,467.18
Rate for Payer: Aetna Medicare Advantage	$1,158.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.55
Rate for Payer: Cigna Commercial	$1,930.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15
Rate for Payer: UnitedHealthcare Community & State	$122.01
Rate for Payer: Wellpoint Medicaid Managed Care	$109.65

FEMORAL DISTAL SZ3 5MM SRW BLK

Facility

$5,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668742
Hospital Revenue Code	278
Min. Negotiated Rate	$154.64
Max. Negotiated Rate	$2,722.50
Rate for Payer: Aetna Commercial	$2,069.10
Rate for Payer: Aetna Medicare Advantage	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,388.47
Rate for Payer: Cigna Commercial	$2,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.69
Rate for Payer: Qualcare PPO/HMO/WC	$816.75
Rate for Payer: UnitedHealthcare Community & State	$172.06
Rate for Payer: Wellpoint Medicaid Managed Care	$154.64

FEMORAL DISTAL SZ3 5MM SRW BLK

Facility

$5,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668742
Hospital Revenue Code	278
Min. Negotiated Rate	$816.75
Max. Negotiated Rate	$1,317.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,089.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.69
Rate for Payer: Qualcare PPO/HMO/WC	$816.75

FEMORAL DIS TRAY CONTOUR LOCK

Facility

$2,475.00

Hospital Charge Code	270675926
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

FEMORAL DIS TRAY CONTOUR LOCK

Facility

$2,475.00

Hospital Charge Code	270675926
Hospital Revenue Code	272
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$643.50
Rate for Payer: Oxford Commercial	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$495.00
Rate for Payer: UnitedHealthcare Community & State	$78.21
Rate for Payer: Wellpoint Medicaid Managed Care	$70.29

FEMORAL ECHO POR RPP

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690589
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

FEMORAL ECHO POR RPP

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690589
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

FEMORAL GMK CEMENTED SZ5 RIGH

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678629
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMORAL GMK CEMENTED SZ5 RIGH

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678629
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

FEMORAL HD BIPOLAR UNI 26X41MM

Facility

$2,743.55

Service Code	HCPCS C1776
Hospital Charge Code	270695308
Hospital Revenue Code	278
Min. Negotiated Rate	$411.53
Max. Negotiated Rate	$663.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.94
Rate for Payer: Qualcare PPO/HMO/WC	$411.53

FEMORAL HD BIPOLAR UNI 26X41MM

Facility

$2,743.55

Service Code	HCPCS C1776
Hospital Charge Code	270695308
Hospital Revenue Code	278
Min. Negotiated Rate	$77.92
Max. Negotiated Rate	$1,371.78
Rate for Payer: Aetna Commercial	$1,042.55
Rate for Payer: Aetna Medicare Advantage	$823.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.61
Rate for Payer: Cigna Commercial	$1,371.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.94
Rate for Payer: Qualcare PPO/HMO/WC	$411.53
Rate for Payer: UnitedHealthcare Community & State	$86.70
Rate for Payer: Wellpoint Medicaid Managed Care	$77.92

FEMORAL HEAD

Facility

$1,712.00

Hospital Charge Code	270335023
Hospital Revenue Code	278
Min. Negotiated Rate	$256.80
Max. Negotiated Rate	$414.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$342.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.30
Rate for Payer: Qualcare PPO/HMO/WC	$256.80

FEMORAL HEAD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686378
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

FEMORAL HEAD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686378
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

FEMORAL HEAD

Facility

$1,712.00

Hospital Charge Code	270335023
Hospital Revenue Code	278
Min. Negotiated Rate	$48.62
Max. Negotiated Rate	$856.00
Rate for Payer: Aetna Commercial	$650.56
Rate for Payer: Aetna Medicare Advantage	$513.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$342.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.56
Rate for Payer: Cigna Commercial	$856.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.30
Rate for Payer: Qualcare PPO/HMO/WC	$256.80
Rate for Payer: UnitedHealthcare Community & State	$54.10
Rate for Payer: Wellpoint Medicaid Managed Care	$48.62

FEMORAL HEAD 12/14 TAPER +0MM

Facility

$2,000.00

Hospital Charge Code	270676225
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

FEMORAL HEAD 12/14 TAPER +0MM

Facility

$2,000.00

Hospital Charge Code	270676225
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FEMORAL HEAD 12/14 TAPER 28MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675312
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

FEMORAL HEAD 12/14 TAPER 28MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675312
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FEMORAL HEAD 28mm +0mm 12/14

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675060
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FEMORAL HEAD 28mm +0mm 12/14

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675060
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

FEMORAL HEAD 28 MM 3 1/15

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270701916
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Know your out-of-pocket cost for care.

All Charges