Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL PS ATTUNE 52 MM 7 RT

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686059
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

FEMORAL PS ATTUNE 52 MM 7 RT

Facility

$10,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673973
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

FEMORAL PS ATTUNE 52 MM 7 RT

Facility

$10,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673973
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

FEMORAL PS CMT CCR STD SZ4

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690739
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

FEMORAL PS CMT CCR STD SZ4

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690739
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PS CMT CCR STD SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692692
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PS CMT CCR STD SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692692
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

FEMORAL PS CMT CCR STD SZ 9 R

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689752
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

FEMORAL PS CMT CCR STD SZ 9 R

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689752
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PS COMPONENT 72.5mm LT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270641310
Hospital Revenue Code	278
Min. Negotiated Rate	$489.33
Max. Negotiated Rate	$8,615.00
Rate for Payer: Aetna Commercial	$6,547.40
Rate for Payer: Aetna Medicare Advantage	$5,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,393.65
Rate for Payer: Cigna Commercial	$8,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50
Rate for Payer: UnitedHealthcare Community & State	$544.47
Rate for Payer: Wellpoint Medicaid Managed Care	$489.33

FEMORAL PS COMPONENT 72.5mm LT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270641310
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$4,169.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

FEMORAL P/S LEFT 70 183132

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639107
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

FEMORAL P/S LEFT 70 183132

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639107
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PSN CCR NRW SZ7

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690107
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

FEMORAL PSN CCR NRW SZ7

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690107
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PSN CMT CCR SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690102
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

FEMORAL PSN CMT CCR SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690102
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PSN PS CMT SZ 8

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690742
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

FEMORAL PSN PS CMT SZ 8

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690742
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PS OPEN BOX 60mm LEFT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646502
Hospital Revenue Code	278
Min. Negotiated Rate	$489.33
Max. Negotiated Rate	$8,615.00
Rate for Payer: Aetna Commercial	$6,547.40
Rate for Payer: Aetna Medicare Advantage	$5,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,393.65
Rate for Payer: Cigna Commercial	$8,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50
Rate for Payer: UnitedHealthcare Community & State	$544.47
Rate for Payer: Wellpoint Medicaid Managed Care	$489.33

FEMORAL PS OPEN BOX 60mm LEFT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646502
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$4,169.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

FEMORAL PS OPEN BOX 62.5MM LFT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270677827
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$2,674.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

FEMORAL PS OPEN BOX 62.5MM LFT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270677827
Hospital Revenue Code	278
Min. Negotiated Rate	$313.82
Max. Negotiated Rate	$5,525.00
Rate for Payer: Aetna Commercial	$4,199.00
Rate for Payer: Aetna Medicare Advantage	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,817.75
Rate for Payer: Cigna Commercial	$5,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50
Rate for Payer: UnitedHealthcare Community & State	$349.18
Rate for Payer: Wellpoint Medicaid Managed Care	$313.82

FEMORAL PS OPEN BOX 65MM RT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270647013
Hospital Revenue Code	278
Min. Negotiated Rate	$313.82
Max. Negotiated Rate	$5,525.00
Rate for Payer: Aetna Commercial	$4,199.00
Rate for Payer: Aetna Medicare Advantage	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,817.75
Rate for Payer: Cigna Commercial	$5,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50
Rate for Payer: UnitedHealthcare Community & State	$349.18
Rate for Payer: Wellpoint Medicaid Managed Care	$313.82

FEMORAL PS OPEN BOX 65MM RT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270647013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$2,674.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

Know your out-of-pocket cost for care.

All Charges