Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL PS OPEN BOX 67.5mm RT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646612
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 67.5mm RT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646612
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 75MM LEFT

Facility

$11,050.00

Hospital Charge Code	270676548
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 75MM LEFT

Facility

$11,050.00

Hospital Charge Code	270676548
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 P/S RIGHT 70 183112

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639712
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 RIGHT 70 183112

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639712
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 TRIATHL SZ6 RT

Facility

$6,859.95

Service Code	HCPCS C1776
Hospital Charge Code	270691172
Hospital Revenue Code	278
Min. Negotiated Rate	$194.82
Max. Negotiated Rate	$3,429.97
Rate for Payer: Aetna Commercial	$2,606.78
Rate for Payer: Aetna Medicare Advantage	$2,057.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,749.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,749.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,749.29
Rate for Payer: Cigna Commercial	$3,429.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,660.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.99
Rate for Payer: UnitedHealthcare Community & State	$216.77
Rate for Payer: Wellpoint Medicaid Managed Care	$194.82

FEMORAL PS TRIATHL SZ6 RT

Facility

$6,859.95

Service Code	HCPCS C1776
Hospital Charge Code	270691172
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.99
Max. Negotiated Rate	$1,660.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,660.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.99

FEMORAL RPP NC ECHO POR

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692413
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 RPP NC ECHO POR

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692413
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 SHAFT BONE GRAFT

Facility

$6,740.00

Hospital Charge Code	270335490
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 SHAFT BONE GRAFT

Facility

$6,740.00

Hospital Charge Code	270335490
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 SOFT TISSUE FASTENER

Facility

$6,355.00

Service Code	HCPCS C1776
Hospital Charge Code	270679464
Hospital Revenue Code	278
Min. Negotiated Rate	$180.48
Max. Negotiated Rate	$3,177.50
Rate for Payer: Aetna Commercial	$2,414.90
Rate for Payer: Aetna Medicare Advantage	$1,906.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,620.53
Rate for Payer: Cigna Commercial	$3,177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: Qualcare PPO/HMO/WC	$953.25
Rate for Payer: UnitedHealthcare Community & State	$200.82
Rate for Payer: Wellpoint Medicaid Managed Care	$180.48

FEMORAL SOFT TISSUE FASTENER

Facility

$6,355.00

Service Code	HCPCS C1776
Hospital Charge Code	270679464
Hospital Revenue Code	278
Min. Negotiated Rate	$953.25
Max. Negotiated Rate	$1,537.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: Qualcare PPO/HMO/WC	$953.25

FEMORAL SPACER MOLD 60x42MM

Facility

$7,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270672077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,197.00
Max. Negotiated Rate	$1,931.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,596.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,931.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,197.00

FEMORAL SPACER MOLD 60x42MM

Facility

$7,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270672077
Hospital Revenue Code	278
Min. Negotiated Rate	$226.63
Max. Negotiated Rate	$3,990.00
Rate for Payer: Aetna Commercial	$3,032.40
Rate for Payer: Aetna Medicare Advantage	$2,394.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,034.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,034.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,596.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,034.90
Rate for Payer: Cigna Commercial	$3,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,931.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,197.00
Rate for Payer: UnitedHealthcare Community & State	$252.17
Rate for Payer: Wellpoint Medicaid Managed Care	$226.63

FEMORAL SPHERE S3 INSTR SET

Facility

$625.00

Service Code	HCPCS C1776
Hospital Charge Code	270684551
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

FEMORAL SPHERE S3 INSTR SET

Facility

$625.00

Service Code	HCPCS C1776
Hospital Charge Code	270684551
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

FEMORAL SSK 65 RIGHT 183304

Facility

$34,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270647559
Hospital Revenue Code	278
Min. Negotiated Rate	$5,202.75
Max. Negotiated Rate	$8,393.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,937.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,393.77
Rate for Payer: Qualcare PPO/HMO/WC	$5,202.75

FEMORAL SSK 65 RIGHT 183304

Facility

$34,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270647559
Hospital Revenue Code	278
Min. Negotiated Rate	$985.05
Max. Negotiated Rate	$17,342.50
Rate for Payer: Aetna Commercial	$13,180.30
Rate for Payer: Aetna Medicare Advantage	$10,405.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,844.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,844.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,937.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,844.67
Rate for Payer: Cigna Commercial	$17,342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,393.77
Rate for Payer: Qualcare PPO/HMO/WC	$5,202.75
Rate for Payer: UnitedHealthcare Community & State	$1,096.05
Rate for Payer: Wellpoint Medicaid Managed Care	$985.05

FEMORAL SSK 70MM LEFT INTERLOK

Facility

$40,345.00

Hospital Charge Code	270671341
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$9,763.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK 70MM LEFT INTERLOK

Facility

$40,345.00

Hospital Charge Code	270671341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,145.80
Max. Negotiated Rate	$20,172.50
Rate for Payer: Aetna Commercial	$15,331.10
Rate for Payer: Aetna Medicare Advantage	$12,103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,287.98
Rate for Payer: Cigna Commercial	$20,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75
Rate for Payer: UnitedHealthcare Community & State	$1,274.90
Rate for Payer: Wellpoint Medicaid Managed Care	$1,145.80

FEMORAL SSK 75mm RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270669900
Hospital Revenue Code	278
Min. Negotiated Rate	$1,145.80
Max. Negotiated Rate	$20,172.50
Rate for Payer: Aetna Commercial	$15,331.10
Rate for Payer: Aetna Medicare Advantage	$12,103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,287.98
Rate for Payer: Cigna Commercial	$20,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75
Rate for Payer: UnitedHealthcare Community & State	$1,274.90
Rate for Payer: Wellpoint Medicaid Managed Care	$1,145.80

FEMORAL SSK 75mm RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270669900
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$9,763.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK 75MM RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270183308
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$9,763.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

Know your out-of-pocket cost for care.

All Charges