Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL SSK 75MM RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270183308
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 RIGHT 50mm

Facility

$39,540.00

Hospital Charge Code	270675556
Hospital Revenue Code	278
Min. Negotiated Rate	$5,931.00
Max. Negotiated Rate	$9,568.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,908.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,568.68
Rate for Payer: Qualcare PPO/HMO/WC	$5,931.00

FEMORAL SSK RIGHT 50mm

Facility

$39,540.00

Hospital Charge Code	270675556
Hospital Revenue Code	278
Min. Negotiated Rate	$1,122.94
Max. Negotiated Rate	$19,770.00
Rate for Payer: Aetna Commercial	$15,025.20
Rate for Payer: Aetna Medicare Advantage	$11,862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,082.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,082.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,908.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,082.70
Rate for Payer: Cigna Commercial	$19,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,568.68
Rate for Payer: Qualcare PPO/HMO/WC	$5,931.00
Rate for Payer: UnitedHealthcare Community & State	$1,249.46
Rate for Payer: Wellpoint Medicaid Managed Care	$1,122.94

FEMORAL STEM 12/14 SZ 13 155MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678420
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 STEM 12/14 SZ 13 155MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678420
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 STEM 12/14 TAP CEMENT

Facility

$9,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270691682
Hospital Revenue Code	278
Min. Negotiated Rate	$256.31
Max. Negotiated Rate	$4,512.50
Rate for Payer: Aetna Commercial	$3,429.50
Rate for Payer: Aetna Medicare Advantage	$2,707.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,301.38
Rate for Payer: Cigna Commercial	$4,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75
Rate for Payer: UnitedHealthcare Community & State	$285.19
Rate for Payer: Wellpoint Medicaid Managed Care	$256.31

FEMORAL STEM 12/14 TAP CEMENT

Facility

$9,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270691682
Hospital Revenue Code	278
Min. Negotiated Rate	$1,353.75
Max. Negotiated Rate	$2,184.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75

FEMORAL STEM 12/14 TAPER

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270690555
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

FEMORAL STEM 12/14 TAPER

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270690555
Hospital Revenue Code	278
Min. Negotiated Rate	$404.70
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$450.30
Rate for Payer: Wellpoint Medicaid Managed Care	$404.70

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688105
Hospital Revenue Code	278
Min. Negotiated Rate	$404.70
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$450.30
Rate for Payer: Wellpoint Medicaid Managed Care	$404.70

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688892
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688892
Hospital Revenue Code	278
Min. Negotiated Rate	$404.70
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$450.30
Rate for Payer: Wellpoint Medicaid Managed Care	$404.70

FEMORAL STEM 12/14 TPR SZ11

Facility

$6,930.00

Service Code	HCPCS C1776
Hospital Charge Code	270700570
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

FEMORAL STEM 12/14 TPR SZ11

Facility

$6,930.00

Service Code	HCPCS C1776
Hospital Charge Code	270700570
Hospital Revenue Code	278
Min. Negotiated Rate	$196.81
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,633.40
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50
Rate for Payer: UnitedHealthcare Community & State	$218.99
Rate for Payer: Wellpoint Medicaid Managed Care	$196.81

FEMORAL STEM ECHO 11X135MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691269
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 STEM ECHO 11X135MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691269
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 STEM NOVA 12/14 SZ17

Facility

$12,998.00

Hospital Charge Code	270670574
Hospital Revenue Code	278
Min. Negotiated Rate	$369.14
Max. Negotiated Rate	$6,499.00
Rate for Payer: Aetna Commercial	$4,939.24
Rate for Payer: Aetna Medicare Advantage	$3,899.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.49
Rate for Payer: Cigna Commercial	$6,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.70
Rate for Payer: UnitedHealthcare Community & State	$410.74
Rate for Payer: Wellpoint Medicaid Managed Care	$369.14

FEMORAL STEM NOVA 12/14 SZ17

Facility

$12,998.00

Hospital Charge Code	270670574
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.70
Max. Negotiated Rate	$3,145.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.70

FEMORAL STEM OFF POROUS SZ 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672470
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 STEM OFF POROUS SZ 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672470
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 STEM OFF POROUS SZ 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672471
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 STEM OFF POROUS SZ 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672471
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 STEM OFF POROUS SZ 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672472
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 STEM OFF POROUS SZ 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672472
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

Know your out-of-pocket cost for care.

All Charges