Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMUR 1 VIEW RT

Facility

$5,100.00

Service Code	HCPCS 73551RT
Hospital Charge Code	2011555
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

FEMUR 1 VIEW RT

Facility

$5,100.00

Service Code	HCPCS 73551RT
Hospital Charge Code	2011555
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FEMUR ADVANCE PRIM POR LT SZ4

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697443
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

FEMUR ADVANCE PRIM POR LT SZ4

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697443
Hospital Revenue Code	278
Min. Negotiated Rate	$326.60
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$363.40
Rate for Payer: Wellpoint Medicaid Managed Care	$326.60

FEMUR ADVANCE PRI NONPOR LTSZ4

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697442
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

FEMUR ADVANCE PRI NONPOR LTSZ4

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697442
Hospital Revenue Code	278
Min. Negotiated Rate	$326.60
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$363.40
Rate for Payer: Wellpoint Medicaid Managed Care	$326.60

FEMUR ADVANCE STATUR PF LT SZ4

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697444
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

FEMUR ADVANCE STATUR PF LT SZ4

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697444
Hospital Revenue Code	278
Min. Negotiated Rate	$326.60
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$363.40
Rate for Payer: Wellpoint Medicaid Managed Care	$326.60

FEMUR AVENIR CMPL HA STD SZ 5

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270695050
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

FEMUR AVENIR CMPL HA STD SZ 5

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270695050
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

FEMUR AVENIR COMPLETE HA SZ 2

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270698038
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

FEMUR AVENIR COMPLETE HA SZ 2

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270698038
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

FEMUR AVENIR COMPLETE HA SZ 6

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270697997
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

FEMUR AVENIR COMPLETE HA SZ 6

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270697997
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

FEMUR AVENIR COPL HA HO COL

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270697932
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

FEMUR AVENIR COPL HA HO COL

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270697932
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

FEMUR AXIAL PIN ELEOS SZ 2

Facility

$11,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270682841
Hospital Revenue Code	278
Min. Negotiated Rate	$1,653.75
Max. Negotiated Rate	$2,668.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,668.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,653.75

FEMUR AXIAL PIN ELEOS SZ 2

Facility

$11,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270682841
Hospital Revenue Code	278
Min. Negotiated Rate	$313.11
Max. Negotiated Rate	$5,512.50
Rate for Payer: Aetna Commercial	$4,189.50
Rate for Payer: Aetna Medicare Advantage	$3,307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,811.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,811.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,811.38
Rate for Payer: Cigna Commercial	$5,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,668.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,653.75
Rate for Payer: UnitedHealthcare Community & State	$348.39
Rate for Payer: Wellpoint Medicaid Managed Care	$313.11

FEMUR BONE

Facility

$500.00

Hospital Charge Code	270671826
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

FEMUR BONE

Facility

$500.00

Hospital Charge Code	270671826
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

FEMUR BONE MODEL LEFT

Facility

$500.00

Hospital Charge Code	270673960
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

FEMUR BONE MODEL LEFT

Facility

$500.00

Hospital Charge Code	270673960
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

FEMUR CEMENTED RIGHT SZ 6 STD

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689504
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

FEMUR CEMENTED RIGHT SZ 6 STD

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689504
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

FEMUR CEMENTED STD SZ 9

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270699093
Hospital Revenue Code	278
Min. Negotiated Rate	$1,511.31
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,681.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1,511.31

Know your out-of-pocket cost for care.

All Charges