Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMUR HEAD BIOLOX OPT 32 MM

Facility

$15,164.45

Service Code	HCPCS C1776
Hospital Charge Code	270698332
Hospital Revenue Code	278
Min. Negotiated Rate	$430.67
Max. Negotiated Rate	$7,582.23
Rate for Payer: Aetna Commercial	$5,762.49
Rate for Payer: Aetna Medicare Advantage	$4,549.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,866.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,866.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,032.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,866.93
Rate for Payer: Cigna Commercial	$7,582.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,669.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,274.67
Rate for Payer: UnitedHealthcare Community & State	$479.20
Rate for Payer: Wellpoint Medicaid Managed Care	$430.67

FEMUR HEAD BIOLOX OPT 32 MM

Facility

$15,164.45

Service Code	HCPCS C1776
Hospital Charge Code	270698332
Hospital Revenue Code	278
Min. Negotiated Rate	$2,274.67
Max. Negotiated Rate	$3,669.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,032.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,669.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,274.67

FEMUR HEAD DELTA BIOLOX 28MM

Facility

$6,412.50

Service Code	HCPCS C1776
Hospital Charge Code	270698149
Hospital Revenue Code	278
Min. Negotiated Rate	$961.88
Max. Negotiated Rate	$1,551.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.83
Rate for Payer: Qualcare PPO/HMO/WC	$961.88

FEMUR HEAD DELTA BIOLOX 28MM

Facility

$6,412.50

Service Code	HCPCS C1776
Hospital Charge Code	270698149
Hospital Revenue Code	278
Min. Negotiated Rate	$182.12
Max. Negotiated Rate	$3,206.25
Rate for Payer: Aetna Commercial	$2,436.75
Rate for Payer: Aetna Medicare Advantage	$1,923.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,635.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,635.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,282.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,635.19
Rate for Payer: Cigna Commercial	$3,206.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.83
Rate for Payer: Qualcare PPO/HMO/WC	$961.88
Rate for Payer: UnitedHealthcare Community & State	$202.63
Rate for Payer: Wellpoint Medicaid Managed Care	$182.12

FEMUR IMPLANT

Facility

$27,159.00

Hospital Charge Code	270339092
Hospital Revenue Code	278
Min. Negotiated Rate	$4,073.85
Max. Negotiated Rate	$6,572.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,431.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,572.48
Rate for Payer: Qualcare PPO/HMO/WC	$4,073.85

FEMUR IMPLANT

Facility

$27,159.00

Hospital Charge Code	270339092
Hospital Revenue Code	278
Min. Negotiated Rate	$771.32
Max. Negotiated Rate	$13,579.50
Rate for Payer: Aetna Commercial	$10,320.42
Rate for Payer: Aetna Medicare Advantage	$8,147.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,925.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,925.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,431.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,925.55
Rate for Payer: Cigna Commercial	$13,579.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,572.48
Rate for Payer: Qualcare PPO/HMO/WC	$4,073.85
Rate for Payer: UnitedHealthcare Community & State	$858.22
Rate for Payer: Wellpoint Medicaid Managed Care	$771.32

FEMUR KNEE SAIPH 4 LEFT

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270680031
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

FEMUR KNEE SAIPH 4 LEFT

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270680031
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

FEMUR KNEE SYSTEM SZ 11

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690960
Hospital Revenue Code	278
Min. Negotiated Rate	$145.69
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$162.11
Rate for Payer: Wellpoint Medicaid Managed Care	$145.69

FEMUR KNEE SYSTEM SZ 11

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690960
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

FEMUR L 62.5MM VNGD SSK 360

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270687242
Hospital Revenue Code	278
Min. Negotiated Rate	$5,445.00
Max. Negotiated Rate	$8,784.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00

FEMUR L 62.5MM VNGD SSK 360

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270687242
Hospital Revenue Code	278
Min. Negotiated Rate	$1,030.92
Max. Negotiated Rate	$18,150.00
Rate for Payer: Aetna Commercial	$13,794.00
Rate for Payer: Aetna Medicare Advantage	$10,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,256.50
Rate for Payer: Cigna Commercial	$18,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00
Rate for Payer: UnitedHealthcare Community & State	$1,147.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,030.92

FEMUR LINER G7 VITE FREE 36MM

Facility

$24,995.35

Service Code	HCPCS C1776
Hospital Charge Code	270698165
Hospital Revenue Code	278
Min. Negotiated Rate	$709.87
Max. Negotiated Rate	$12,497.67
Rate for Payer: Aetna Commercial	$9,498.23
Rate for Payer: Aetna Medicare Advantage	$7,498.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.81
Rate for Payer: Cigna Commercial	$12,497.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.87
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.30
Rate for Payer: UnitedHealthcare Community & State	$789.85
Rate for Payer: Wellpoint Medicaid Managed Care	$709.87

FEMUR LINER G7 VITE FREE 36MM

Facility

$24,995.35

Service Code	HCPCS C1776
Hospital Charge Code	270698165
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.30
Max. Negotiated Rate	$6,048.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.87
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.30

FEMUR MIN 2 VIEWS BILAT

Facility

$358.23

Service Code	HCPCS 7355250
Hospital Charge Code	94270263
Hospital Revenue Code	320
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.14
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$11.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.17

FEMUR MIN 2 VIEWS BILAT

Facility

$6,601.19

Service Code	HCPCS 7355250
Hospital Charge Code	2011594
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

FEMUR MIN 2 VIEWS BILAT

Facility

$6,601.19

Service Code	HCPCS 7355250
Hospital Charge Code	2011594
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FEMUR MIN 2 VIEWS BILAT

Facility

$6,601.19

Service Code	HCPCS 7355250
Hospital Charge Code	94061484
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

FEMUR MIN 2 VIEWS BILAT

Facility

$358.23

Service Code	HCPCS 7355250
Hospital Charge Code	94270263
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

FEMUR MIN 2 VIEWS BILAT

Facility

$358.23

Service Code	HCPCS 7355250
Hospital Charge Code	75190638
Hospital Revenue Code	320
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.14
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$11.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.17

FEMUR MIN 2 VIEWS BILAT

Facility

$358.23

Service Code	HCPCS 7355250
Hospital Charge Code	75190638
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

FEMUR MIN 2 VIEWS BILAT

Facility

$6,601.19

Service Code	HCPCS 7355250
Hospital Charge Code	94061484
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FEMUR MIN 2 VIEWS LT

Facility

$358.23

Service Code	HCPCS 73552LT
Hospital Charge Code	94270271
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

FEMUR MIN 2 VIEWS LT

Facility

$6,601.19

Service Code	HCPCS 73552LT
Hospital Charge Code	94061491
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FEMUR MIN 2 VIEWS LT

Facility

$358.23

Service Code	HCPCS 73552LT
Hospital Charge Code	75190644
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

Know your out-of-pocket cost for care.

All Charges