Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL HEAD DELTA 28MM/M

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270669779
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 DELTA 28MM/M

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270669779
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 DELTA 28MM/S/-3.5

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667470
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 DELTA 28MM/S/-3.5

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667470
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 DELTA 32MM +0MM

Facility

$16,325.00

Hospital Charge Code	270670946
Hospital Revenue Code	278
Min. Negotiated Rate	$2,448.75
Max. Negotiated Rate	$3,950.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,950.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,448.75

FEMORAL HEAD DELTA 32MM +0MM

Facility

$16,325.00

Hospital Charge Code	270670947
Hospital Revenue Code	278
Min. Negotiated Rate	$2,448.75
Max. Negotiated Rate	$3,950.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,950.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,448.75

FEMORAL HEAD DELTA 32MM +0MM

Facility

$16,325.00

Hospital Charge Code	270670946
Hospital Revenue Code	278
Min. Negotiated Rate	$463.63
Max. Negotiated Rate	$8,162.50
Rate for Payer: Aetna Commercial	$6,203.50
Rate for Payer: Aetna Medicare Advantage	$4,897.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,162.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,162.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,162.88
Rate for Payer: Cigna Commercial	$8,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,950.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,448.75
Rate for Payer: UnitedHealthcare Community & State	$515.87
Rate for Payer: Wellpoint Medicaid Managed Care	$463.63

FEMORAL HEAD DELTA 32MM +0MM

Facility

$16,325.00

Hospital Charge Code	270670947
Hospital Revenue Code	278
Min. Negotiated Rate	$463.63
Max. Negotiated Rate	$8,162.50
Rate for Payer: Aetna Commercial	$6,203.50
Rate for Payer: Aetna Medicare Advantage	$4,897.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,162.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,162.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,162.88
Rate for Payer: Cigna Commercial	$8,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,950.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,448.75
Rate for Payer: UnitedHealthcare Community & State	$515.87
Rate for Payer: Wellpoint Medicaid Managed Care	$463.63

FEMORAL HEAD DELTA 32MM L

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683439
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 DELTA 32MM L

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683439
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 FREETI 36MMX3MM

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270698166
Hospital Revenue Code	278
Min. Negotiated Rate	$224.93
Max. Negotiated Rate	$3,960.00
Rate for Payer: Aetna Commercial	$3,009.60
Rate for Payer: Aetna Medicare Advantage	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.60
Rate for Payer: Cigna Commercial	$3,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00
Rate for Payer: UnitedHealthcare Community & State	$250.27
Rate for Payer: Wellpoint Medicaid Managed Care	$224.93

FEMORAL HEAD FREETI 36MMX3MM

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270698166
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.00
Max. Negotiated Rate	$1,916.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00

FEMORAL HEAD FROZEN

Facility

$6,740.00

Service Code	HCPCS C1776
Hospital Charge Code	270655601
Hospital Revenue Code	278
Min. Negotiated Rate	$191.42
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,561.20
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00
Rate for Payer: UnitedHealthcare Community & State	$212.98
Rate for Payer: Wellpoint Medicaid Managed Care	$191.42

FEMORAL HEAD FROZEN

Facility

$6,740.00

Service Code	HCPCS C1776
Hospital Charge Code	270655601
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,631.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

FEMORAL HEAD LFIT

Facility

$5,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270660306
Hospital Revenue Code	278
Min. Negotiated Rate	$166.99
Max. Negotiated Rate	$2,940.00
Rate for Payer: Aetna Commercial	$2,234.40
Rate for Payer: Aetna Medicare Advantage	$1,764.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,499.40
Rate for Payer: Cigna Commercial	$2,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,422.96
Rate for Payer: Qualcare PPO/HMO/WC	$882.00
Rate for Payer: UnitedHealthcare Community & State	$185.81
Rate for Payer: Wellpoint Medicaid Managed Care	$166.99

FEMORAL HEAD LFIT

Facility

$5,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270660306
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,422.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,422.96
Rate for Payer: Qualcare PPO/HMO/WC	$882.00

FEMORAL HEAD LFIT V40 28MM +4

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270671838
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 LFIT V40 28MM +4

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270671838
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 LIFT V40 28MM +0

Facility

$2,792.25

Service Code	HCPCS C1776
Hospital Charge Code	270656524
Hospital Revenue Code	278
Min. Negotiated Rate	$418.84
Max. Negotiated Rate	$675.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$558.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.72
Rate for Payer: Qualcare PPO/HMO/WC	$418.84

FEMORAL HEAD LIFT V40 28MM +0

Facility

$2,792.25

Service Code	HCPCS C1776
Hospital Charge Code	270656524
Hospital Revenue Code	278
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$1,396.12
Rate for Payer: Aetna Commercial	$1,061.06
Rate for Payer: Aetna Medicare Advantage	$837.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$712.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$712.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$558.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$712.02
Rate for Payer: Cigna Commercial	$1,396.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.72
Rate for Payer: Qualcare PPO/HMO/WC	$418.84
Rate for Payer: UnitedHealthcare Community & State	$88.24
Rate for Payer: Wellpoint Medicaid Managed Care	$79.30

FEMORAL HEAD MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689573
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 MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689593
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 MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689573
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 MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689593
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 OD 28MM OFFST 8MM

Facility

$2,792.25

Service Code	HCPCS C1776
Hospital Charge Code	270695124
Hospital Revenue Code	278
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$1,396.12
Rate for Payer: Aetna Commercial	$1,061.06
Rate for Payer: Aetna Medicare Advantage	$837.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$712.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$712.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$558.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$712.02
Rate for Payer: Cigna Commercial	$1,396.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.72
Rate for Payer: Qualcare PPO/HMO/WC	$418.84
Rate for Payer: UnitedHealthcare Community & State	$88.24
Rate for Payer: Wellpoint Medicaid Managed Care	$79.30

Know your out-of-pocket cost for care.

All Charges