Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GLENOID BASE 4MM SM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687323
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

GLENOID BASE 4MM SM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687323
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

GLENOID BASE PLATE

Facility

$12,057.50

Service Code	HCPCS C1776
Hospital Charge Code	270688866
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$2,917.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

GLENOID BASE PLATE

Facility

$12,057.50

Service Code	HCPCS C1776
Hospital Charge Code	270688866
Hospital Revenue Code	278
Min. Negotiated Rate	$342.43
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$4,581.85
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62
Rate for Payer: UnitedHealthcare Community & State	$381.02
Rate for Payer: Wellpoint Medicaid Managed Care	$342.43

GLENOID BASEPLATE

Facility

$6,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270688088
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

GLENOID BASEPLATE

Facility

$6,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270688088
Hospital Revenue Code	278
Min. Negotiated Rate	$178.92
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: Aetna Medicare Advantage	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,606.50
Rate for Payer: Cigna Commercial	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00
Rate for Payer: UnitedHealthcare Community & State	$199.08
Rate for Payer: Wellpoint Medicaid Managed Care	$178.92

GLENOID BASEPLATE 22X15

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696734
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

GLENOID BASEPLATE 22X15

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696734
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

GLENOID BASEPLATE 27 X 15

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687831
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

GLENOID BASEPLATE 27 X 15

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687831
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

GLENOID FOSS LNR TM REV 36MM

Facility

$5,225.00

Service Code	HCPCS C1776
Hospital Charge Code	270696096
Hospital Revenue Code	278
Min. Negotiated Rate	$148.39
Max. Negotiated Rate	$2,612.50
Rate for Payer: Aetna Commercial	$1,985.50
Rate for Payer: Aetna Medicare Advantage	$1,567.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,332.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,332.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,332.38
Rate for Payer: Cigna Commercial	$2,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.45
Rate for Payer: Qualcare PPO/HMO/WC	$783.75
Rate for Payer: UnitedHealthcare Community & State	$165.11
Rate for Payer: Wellpoint Medicaid Managed Care	$148.39

GLENOID FOSS LNR TM REV 36MM

Facility

$5,225.00

Service Code	HCPCS C1776
Hospital Charge Code	270696096
Hospital Revenue Code	278
Min. Negotiated Rate	$783.75
Max. Negotiated Rate	$1,264.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.45
Rate for Payer: Qualcare PPO/HMO/WC	$783.75

GLENOID FOSS TM RES SPACER 9MM

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270696097
Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$747.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: Qualcare PPO/HMO/WC	$463.12

GLENOID FOSS TM RES SPACER 9MM

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270696097
Hospital Revenue Code	278
Min. Negotiated Rate	$87.69
Max. Negotiated Rate	$1,543.75
Rate for Payer: Aetna Commercial	$1,173.25
Rate for Payer: Aetna Medicare Advantage	$926.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$787.31
Rate for Payer: Cigna Commercial	$1,543.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: Qualcare PPO/HMO/WC	$463.12
Rate for Payer: UnitedHealthcare Community & State	$97.56
Rate for Payer: Wellpoint Medicaid Managed Care	$87.69

GLENOID GUIDE PIN 2.5MM

Facility

$750.00

Hospital Charge Code	270704576
Hospital Revenue Code	279
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GLENOID GUIDE PIN 2.5MM

Facility

$750.00

Hospital Charge Code	270704576
Hospital Revenue Code	279
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

GLENOID, HEAD58-54MM

Facility

$8,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270687340
Hospital Revenue Code	278
Min. Negotiated Rate	$240.26
Max. Negotiated Rate	$4,230.00
Rate for Payer: Aetna Commercial	$3,214.80
Rate for Payer: Aetna Medicare Advantage	$2,538.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,692.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,157.30
Rate for Payer: Cigna Commercial	$4,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,047.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00
Rate for Payer: UnitedHealthcare Community & State	$267.34
Rate for Payer: Wellpoint Medicaid Managed Care	$240.26

GLENOID, HEAD58-54MM

Facility

$8,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270687340
Hospital Revenue Code	278
Min. Negotiated Rate	$1,269.00
Max. Negotiated Rate	$2,047.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,692.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,047.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00

GLENOID METAL BACK LARGE

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270680275
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$1,456.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

GLENOID METAL BACK LARGE

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270680275
Hospital Revenue Code	278
Min. Negotiated Rate	$170.97
Max. Negotiated Rate	$3,010.00
Rate for Payer: Aetna Commercial	$2,287.60
Rate for Payer: Aetna Medicare Advantage	$1,806.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,535.10
Rate for Payer: Cigna Commercial	$3,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00
Rate for Payer: UnitedHealthcare Community & State	$190.23
Rate for Payer: Wellpoint Medicaid Managed Care	$170.97

GLENOID METAL BACK SMALL

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672311
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$1,456.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

GLENOID METAL BACK SMALL

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672311
Hospital Revenue Code	278
Min. Negotiated Rate	$170.97
Max. Negotiated Rate	$3,010.00
Rate for Payer: Aetna Commercial	$2,287.60
Rate for Payer: Aetna Medicare Advantage	$1,806.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,535.10
Rate for Payer: Cigna Commercial	$3,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00
Rate for Payer: UnitedHealthcare Community & State	$190.23
Rate for Payer: Wellpoint Medicaid Managed Care	$170.97

GLENOID METAL BACK STANDARD

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270675412
Hospital Revenue Code	278
Min. Negotiated Rate	$1,878.75
Max. Negotiated Rate	$3,031.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75

GLENOID METAL BACK STANDARD

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270675412
Hospital Revenue Code	278
Min. Negotiated Rate	$355.71
Max. Negotiated Rate	$6,262.50
Rate for Payer: Aetna Commercial	$4,759.50
Rate for Payer: Aetna Medicare Advantage	$3,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,193.88
Rate for Payer: Cigna Commercial	$6,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75
Rate for Payer: UnitedHealthcare Community & State	$395.79
Rate for Payer: Wellpoint Medicaid Managed Care	$355.71

GLENOID MOD 4 PEG SZ4

Facility

$8,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270699889
Hospital Revenue Code	278
Min. Negotiated Rate	$228.62
Max. Negotiated Rate	$4,025.00
Rate for Payer: Aetna Commercial	$3,059.00
Rate for Payer: Aetna Medicare Advantage	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,052.75
Rate for Payer: Cigna Commercial	$4,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50
Rate for Payer: UnitedHealthcare Community & State	$254.38
Rate for Payer: Wellpoint Medicaid Managed Care	$228.62

Know your out-of-pocket cost for care.

All Charges