Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL HEAD COCR 3.5MM 36MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669368
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 COCR 36MM/0

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669114
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 36MM/0

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669114
Hospital Revenue Code	278
Min. Negotiated Rate	$50.98
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$56.72
Rate for Payer: Wellpoint Medicaid Managed Care	$50.98

FEMORAL HEAD COCR 36MM/+10.5

Facility

$1,795.00

Hospital Charge Code	270669118
Hospital Revenue Code	278
Min. Negotiated Rate	$50.98
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$56.72
Rate for Payer: Wellpoint Medicaid Managed Care	$50.98

FEMORAL HEAD COCR 36MM/+10.5

Facility

$1,795.00

Hospital Charge Code	270669118
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 36MM/+3.5

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669115
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 36MM/+3.5

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669115
Hospital Revenue Code	278
Min. Negotiated Rate	$50.98
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$56.72
Rate for Payer: Wellpoint Medicaid Managed Care	$50.98

FEMORAL HEAD COCR 36MM/-3.5

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669119
Hospital Revenue Code	278
Min. Negotiated Rate	$50.98
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$56.72
Rate for Payer: Wellpoint Medicaid Managed Care	$50.98

FEMORAL HEAD COCR 36MM/-3.5

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669119
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 36MM/+7

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669116
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 36MM/+7

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669116
Hospital Revenue Code	278
Min. Negotiated Rate	$50.98
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$56.72
Rate for Payer: Wellpoint Medicaid Managed Care	$50.98

FEMORAL HEAD COCR 40MM/0

Facility

$2,255.00

Hospital Charge Code	270669120
Hospital Revenue Code	278
Min. Negotiated Rate	$64.04
Max. Negotiated Rate	$1,127.50
Rate for Payer: Aetna Commercial	$856.90
Rate for Payer: Aetna Medicare Advantage	$676.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.02
Rate for Payer: Cigna Commercial	$1,127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: Qualcare PPO/HMO/WC	$338.25
Rate for Payer: UnitedHealthcare Community & State	$71.26
Rate for Payer: Wellpoint Medicaid Managed Care	$64.04

FEMORAL HEAD COCR 40MM/0

Facility

$2,255.00

Hospital Charge Code	270669120
Hospital Revenue Code	278
Min. Negotiated Rate	$338.25
Max. Negotiated Rate	$545.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: Qualcare PPO/HMO/WC	$338.25

FEMORAL HEAD COCR 40MM/+10.5

Facility

$2,255.00

Hospital Charge Code	270669123
Hospital Revenue Code	278
Min. Negotiated Rate	$338.25
Max. Negotiated Rate	$545.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: Qualcare PPO/HMO/WC	$338.25

FEMORAL HEAD COCR 40MM/+10.5

Facility

$2,255.00

Hospital Charge Code	270669123
Hospital Revenue Code	278
Min. Negotiated Rate	$64.04
Max. Negotiated Rate	$1,127.50
Rate for Payer: Aetna Commercial	$856.90
Rate for Payer: Aetna Medicare Advantage	$676.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.02
Rate for Payer: Cigna Commercial	$1,127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: Qualcare PPO/HMO/WC	$338.25
Rate for Payer: UnitedHealthcare Community & State	$71.26
Rate for Payer: Wellpoint Medicaid Managed Care	$64.04

FEMORAL HEAD COCR 40MM/+3.5

Facility

$2,255.00

Hospital Charge Code	270669121
Hospital Revenue Code	278
Min. Negotiated Rate	$64.04
Max. Negotiated Rate	$1,127.50
Rate for Payer: Aetna Commercial	$856.90
Rate for Payer: Aetna Medicare Advantage	$676.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.02
Rate for Payer: Cigna Commercial	$1,127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: Qualcare PPO/HMO/WC	$338.25
Rate for Payer: UnitedHealthcare Community & State	$71.26
Rate for Payer: Wellpoint Medicaid Managed Care	$64.04

FEMORAL HEAD COCR 40MM/+3.5

Facility

$2,255.00

Hospital Charge Code	270669121
Hospital Revenue Code	278
Min. Negotiated Rate	$338.25
Max. Negotiated Rate	$545.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: Qualcare PPO/HMO/WC	$338.25

FEMORAL HEAD COCR 40MM/-3.5

Facility

$2,255.00

Hospital Charge Code	270669124
Hospital Revenue Code	278
Min. Negotiated Rate	$64.04
Max. Negotiated Rate	$1,127.50
Rate for Payer: Aetna Commercial	$856.90
Rate for Payer: Aetna Medicare Advantage	$676.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.02
Rate for Payer: Cigna Commercial	$1,127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: Qualcare PPO/HMO/WC	$338.25
Rate for Payer: UnitedHealthcare Community & State	$71.26
Rate for Payer: Wellpoint Medicaid Managed Care	$64.04

FEMORAL HEAD COCR 40MM/-3.5

Facility

$2,255.00

Hospital Charge Code	270669124
Hospital Revenue Code	278
Min. Negotiated Rate	$338.25
Max. Negotiated Rate	$545.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: Qualcare PPO/HMO/WC	$338.25

FEMORAL HEAD COCR 40MM/+7

Facility

$2,255.00

Hospital Charge Code	270669122
Hospital Revenue Code	278
Min. Negotiated Rate	$338.25
Max. Negotiated Rate	$545.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: Qualcare PPO/HMO/WC	$338.25

FEMORAL HEAD COCR 40MM/+7

Facility

$2,255.00

Hospital Charge Code	270669122
Hospital Revenue Code	278
Min. Negotiated Rate	$64.04
Max. Negotiated Rate	$1,127.50
Rate for Payer: Aetna Commercial	$856.90
Rate for Payer: Aetna Medicare Advantage	$676.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.02
Rate for Payer: Cigna Commercial	$1,127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: Qualcare PPO/HMO/WC	$338.25
Rate for Payer: UnitedHealthcare Community & State	$71.26
Rate for Payer: Wellpoint Medicaid Managed Care	$64.04

FEMORAL HEAD C-TPR 36MM +10

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270672947
Hospital Revenue Code	278
Min. Negotiated Rate	$101.53
Max. Negotiated Rate	$1,787.50
Rate for Payer: Aetna Commercial	$1,358.50
Rate for Payer: Aetna Medicare Advantage	$1,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$911.62
Rate for Payer: Cigna Commercial	$1,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: Qualcare PPO/HMO/WC	$536.25
Rate for Payer: UnitedHealthcare Community & State	$112.97
Rate for Payer: Wellpoint Medicaid Managed Care	$101.53

FEMORAL HEAD C-TPR 36MM +10

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270672947
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$865.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

FEMORAL HEAD C-TPR 36MM -5

Facility

$4,128.25

Hospital Charge Code	270676935
Hospital Revenue Code	278
Min. Negotiated Rate	$619.24
Max. Negotiated Rate	$999.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.04
Rate for Payer: Qualcare PPO/HMO/WC	$619.24

FEMORAL HEAD C-TPR 36MM -5

Facility

$4,128.25

Hospital Charge Code	270676935
Hospital Revenue Code	278
Min. Negotiated Rate	$117.24
Max. Negotiated Rate	$2,064.12
Rate for Payer: Aetna Commercial	$1,568.73
Rate for Payer: Aetna Medicare Advantage	$1,238.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,052.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,052.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,052.70
Rate for Payer: Cigna Commercial	$2,064.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.04
Rate for Payer: Qualcare PPO/HMO/WC	$619.24
Rate for Payer: UnitedHealthcare Community & State	$130.45
Rate for Payer: Wellpoint Medicaid Managed Care	$117.24

Know your out-of-pocket cost for care.

All Charges