Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL STEM STD POROUS SZ 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672462
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 STD POROUS SZ 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672463
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 STD POROUS SZ 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672463
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 STD POROUS SZ 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672464
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 STD POROUS SZ 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672464
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 STD POROUS SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672465
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 STD POROUS SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672465
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 STD POROUS SZ 6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672466
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 STD POROUS SZ 6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672466
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 STD POROUS SZ 7

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672467
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 STD POROUS SZ 7

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672467
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 STD POROUS SZ 8

Facility

$8,000.00

Hospital Charge Code	270672468
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 STD POROUS SZ 8

Facility

$8,000.00

Hospital Charge Code	270672468
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 STD POROUS SZ 9

Facility

$8,000.00

Hospital Charge Code	270672469
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 STD POROUS SZ 9

Facility

$8,000.00

Hospital Charge Code	270672469
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 W/HA COATED SZ 10

Facility

$42,475.00

Hospital Charge Code	270670945
Hospital Revenue Code	278
Min. Negotiated Rate	$1,206.29
Max. Negotiated Rate	$21,237.50
Rate for Payer: Aetna Commercial	$16,140.50
Rate for Payer: Aetna Medicare Advantage	$12,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,831.12
Rate for Payer: Cigna Commercial	$21,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,278.95
Rate for Payer: Qualcare PPO/HMO/WC	$6,371.25
Rate for Payer: UnitedHealthcare Community & State	$1,342.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1,206.29

FEMORAL STEM W/HA COATED SZ 10

Facility

$42,475.00

Hospital Charge Code	270670945
Hospital Revenue Code	278
Min. Negotiated Rate	$6,371.25
Max. Negotiated Rate	$10,278.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,278.95
Rate for Payer: Qualcare PPO/HMO/WC	$6,371.25

FEMORAL SZ3 A/P 62MM, M/L 65MM

Facility

$30,080.00

Service Code	HCPCS C1776
Hospital Charge Code	270668740
Hospital Revenue Code	278
Min. Negotiated Rate	$4,512.00
Max. Negotiated Rate	$7,279.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,016.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,279.36
Rate for Payer: Qualcare PPO/HMO/WC	$4,512.00

FEMORAL SZ3 A/P 62MM, M/L 65MM

Facility

$30,080.00

Service Code	HCPCS C1776
Hospital Charge Code	270668740
Hospital Revenue Code	278
Min. Negotiated Rate	$854.27
Max. Negotiated Rate	$15,040.00
Rate for Payer: Aetna Commercial	$11,430.40
Rate for Payer: Aetna Medicare Advantage	$9,024.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,670.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,670.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,670.40
Rate for Payer: Cigna Commercial	$15,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,279.36
Rate for Payer: Qualcare PPO/HMO/WC	$4,512.00
Rate for Payer: UnitedHealthcare Community & State	$950.53
Rate for Payer: Wellpoint Medicaid Managed Care	$854.27

FEMORAL SZ 5 LEFT PS CEMENTED

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678745
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

FEMORAL SZ 5 LEFT PS CEMENTED

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678745
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

FEMORAL TAPERED STEM STD-SZ 1

Facility

$7,170.00

Hospital Charge Code	270669080
Hospital Revenue Code	278
Min. Negotiated Rate	$203.63
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$226.57
Rate for Payer: Wellpoint Medicaid Managed Care	$203.63

FEMORAL TAPERED STEM STD-SZ 1

Facility

$7,170.00

Hospital Charge Code	270669080
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FEMORAL TAPERED STEM STD-SZ 10

Facility

$7,170.00

Hospital Charge Code	270669089
Hospital Revenue Code	278
Min. Negotiated Rate	$203.63
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$226.57
Rate for Payer: Wellpoint Medicaid Managed Care	$203.63

FEMORAL TAPERED STEM STD-SZ 10

Facility

$7,170.00

Hospital Charge Code	270669089
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

Know your out-of-pocket cost for care.

All Charges