Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEMUR STD CEMENTED 4N RT

Facility

$9,930.00

Service Code	HCPCS C1776
Hospital Charge Code	270673198
Hospital Revenue Code	278
Min. Negotiated Rate	$1,489.50
Max. Negotiated Rate	$2,403.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,986.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,403.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,489.50

FEMUR STD CEMENTED LEFT SZ 3

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671827
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

FEMUR STD CEMENTED LEFT SZ 3

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671827
Hospital Revenue Code	278
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

FEMUR STD CEMENTED SZ3

Facility

$9,930.00

Hospital Charge Code	270673642
Hospital Revenue Code	278
Min. Negotiated Rate	$1,489.50
Max. Negotiated Rate	$2,403.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,986.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,403.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,489.50

FEMUR STD CEMENTED SZ3

Facility

$9,930.00

Hospital Charge Code	270673642
Hospital Revenue Code	278
Min. Negotiated Rate	$282.01
Max. Negotiated Rate	$4,965.00
Rate for Payer: Aetna Commercial	$3,773.40
Rate for Payer: Aetna Medicare Advantage	$2,979.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,532.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,532.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,986.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,532.15
Rate for Payer: Cigna Commercial	$4,965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,403.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,489.50
Rate for Payer: UnitedHealthcare Community & State	$313.79
Rate for Payer: Wellpoint Medicaid Managed Care	$282.01

FEMUR STD CEMENTED SZ 4 LEFT

Facility

$7,500.00

Hospital Charge Code	270675738
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

FEMUR STD CEMENTED SZ 4 LEFT

Facility

$7,500.00

Hospital Charge Code	270675738
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

FEMUR STD PSN SZ10 R

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270695191
Hospital Revenue Code	278
Min. Negotiated Rate	$876.71
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$975.49
Rate for Payer: Wellpoint Medicaid Managed Care	$876.71

FEMUR STD PSN SZ10 R

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270695191
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

FEMUR STEM AVENIR HAHO COL SZ4

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270698497
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 STEM AVENIR HAHO COL SZ4

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270698497
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 SZ 2 ELEOS RESURFACE RT

Facility

$24,690.00

Service Code	HCPCS C1776
Hospital Charge Code	270682842
Hospital Revenue Code	278
Min. Negotiated Rate	$701.20
Max. Negotiated Rate	$12,345.00
Rate for Payer: Aetna Commercial	$9,382.20
Rate for Payer: Aetna Medicare Advantage	$7,407.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,938.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,295.95
Rate for Payer: Cigna Commercial	$12,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,974.98
Rate for Payer: Qualcare PPO/HMO/WC	$3,703.50
Rate for Payer: UnitedHealthcare Community & State	$780.20
Rate for Payer: Wellpoint Medicaid Managed Care	$701.20

FEMUR SZ 2 ELEOS RESURFACE RT

Facility

$24,690.00

Service Code	HCPCS C1776
Hospital Charge Code	270682842
Hospital Revenue Code	278
Min. Negotiated Rate	$3,703.50
Max. Negotiated Rate	$5,974.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,938.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,974.98
Rate for Payer: Qualcare PPO/HMO/WC	$3,703.50

FEMUR TRIATHLON CR SZ 2 CS

Facility

$7,237.65

Service Code	HCPCS C1776
Hospital Charge Code	270695588
Hospital Revenue Code	278
Min. Negotiated Rate	$205.55
Max. Negotiated Rate	$3,618.82
Rate for Payer: Aetna Commercial	$2,750.31
Rate for Payer: Aetna Medicare Advantage	$2,171.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.60
Rate for Payer: Cigna Commercial	$3,618.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.65
Rate for Payer: UnitedHealthcare Community & State	$228.71
Rate for Payer: Wellpoint Medicaid Managed Care	$205.55

FEMUR TRIATHLON CR SZ 2 CS

Facility

$7,237.65

Service Code	HCPCS C1776
Hospital Charge Code	270695588
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.65
Max. Negotiated Rate	$1,751.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.65

FEMUR TRIATHLON CR SZ3 RT

Facility

$7,237.65

Service Code	HCPCS C1776
Hospital Charge Code	270695246
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.65
Max. Negotiated Rate	$1,751.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.65

FEMUR TRIATHLON CR SZ3 RT

Facility

$7,237.65

Service Code	HCPCS C1776
Hospital Charge Code	270695246
Hospital Revenue Code	278
Min. Negotiated Rate	$205.55
Max. Negotiated Rate	$3,618.82
Rate for Payer: Aetna Commercial	$2,750.31
Rate for Payer: Aetna Medicare Advantage	$2,171.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.60
Rate for Payer: Cigna Commercial	$3,618.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.65
Rate for Payer: UnitedHealthcare Community & State	$228.71
Rate for Payer: Wellpoint Medicaid Managed Care	$205.55

FENESTRATED SCREW WASHER 7.3

Facility

$3,272.50

Service Code	HCPCS C1713
Hospital Charge Code	270687081
Hospital Revenue Code	278
Min. Negotiated Rate	$490.88
Max. Negotiated Rate	$791.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$654.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$791.95
Rate for Payer: Qualcare PPO/HMO/WC	$490.88

FENESTRATED SCREW WASHER 7.3

Facility

$3,272.50

Service Code	HCPCS C1713
Hospital Charge Code	270687081
Hospital Revenue Code	278
Min. Negotiated Rate	$92.94
Max. Negotiated Rate	$1,636.25
Rate for Payer: Aetna Commercial	$1,243.55
Rate for Payer: Aetna Medicare Advantage	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$834.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$834.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$654.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$834.49
Rate for Payer: Cigna Commercial	$1,636.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$791.95
Rate for Payer: Qualcare PPO/HMO/WC	$490.88
Rate for Payer: UnitedHealthcare Community & State	$103.41
Rate for Payer: Wellpoint Medicaid Managed Care	$92.94

FENOFIBRATE 145MG TAB

Facility

$32.23

Service Code	NDC 54569575002
Hospital Charge Code	60632250
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$16.11
Rate for Payer: Aetna Commercial	$12.25
Rate for Payer: Aetna Medicare Advantage	$9.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.22
Rate for Payer: Cigna Commercial	$16.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.38
Rate for Payer: Oxford Commercial	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.83
Rate for Payer: UnitedHealthcare Commercial	$6.45
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

FENOFIBRATE 145MG TAB

Facility

$32.23

Service Code	NDC 54569575002
Hospital Charge Code	60632250
Hospital Revenue Code	250
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$4.83

FENOFIBRATE 48MG TAB

Facility

$17.49

Service Code	NDC 54868522400
Hospital Charge Code	60632251
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.74
Rate for Payer: Aetna Commercial	$6.65
Rate for Payer: Aetna Medicare Advantage	$5.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.46
Rate for Payer: Cigna Commercial	$8.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.62
Rate for Payer: UnitedHealthcare Commercial	$3.50
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

FENOFIBRATE 48MG TAB

Facility

$17.49

Service Code	NDC 54868522400
Hospital Charge Code	60632251
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.62

FENO SAMPLING

Facility

$203.74

Service Code	HCPCS 95012
Hospital Charge Code	95090387
Hospital Revenue Code	460
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.97
Rate for Payer: Oxford Commercial	$2,184.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.56
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$6.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

FENO SAMPLING

Facility

$203.74

Service Code	HCPCS 95012
Hospital Charge Code	95090387
Hospital Revenue Code	460
Min. Negotiated Rate	$30.56
Max. Negotiated Rate	$30.56
Rate for Payer: Qualcare PPO/HMO/WC	$30.56

Know your out-of-pocket cost for care.

All Charges