Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GLENOID MOD 4 PEG SZ4

Facility

$8,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270699889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$1,948.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

GLENOID MOD AUGMNT 4PEG LT SZ3

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270699472
Hospital Revenue Code	278
Min. Negotiated Rate	$81.65
Max. Negotiated Rate	$1,437.50
Rate for Payer: Aetna Commercial	$1,092.50
Rate for Payer: Aetna Medicare Advantage	$862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$733.12
Rate for Payer: Cigna Commercial	$1,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: Qualcare PPO/HMO/WC	$431.25
Rate for Payer: UnitedHealthcare Community & State	$90.85
Rate for Payer: Wellpoint Medicaid Managed Care	$81.65

GLENOID MOD AUGMNT 4PEG LT SZ3

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270699472
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$695.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: Qualcare PPO/HMO/WC	$431.25

GLENOID PEGGED BF 52MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683030
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 PEGGED BF 52MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683030
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 PEGGED CEMENTED MED

Facility

$4,905.00

Service Code	HCPCS C1713
Hospital Charge Code	270669867
Hospital Revenue Code	278
Min. Negotiated Rate	$139.30
Max. Negotiated Rate	$2,452.50
Rate for Payer: Aetna Commercial	$1,863.90
Rate for Payer: Aetna Medicare Advantage	$1,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,250.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,250.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,250.78
Rate for Payer: Cigna Commercial	$2,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,187.01
Rate for Payer: Qualcare PPO/HMO/WC	$735.75
Rate for Payer: UnitedHealthcare Community & State	$155.00
Rate for Payer: Wellpoint Medicaid Managed Care	$139.30

GLENOID PEGGED CEMENTED MED

Facility

$4,905.00

Service Code	HCPCS C1713
Hospital Charge Code	270669867
Hospital Revenue Code	278
Min. Negotiated Rate	$735.75
Max. Negotiated Rate	$1,187.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,187.01
Rate for Payer: Qualcare PPO/HMO/WC	$735.75

GLENOID PEG SM MEDIUM

Facility

$7,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270688089
Hospital Revenue Code	278
Min. Negotiated Rate	$218.68
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,926.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$243.32
Rate for Payer: Wellpoint Medicaid Managed Care	$218.68

GLENOID PEG SM MEDIUM

Facility

$7,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270688089
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

GLENOID PEG SPALLA S/STD SHORT

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270673213
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 PEG SPALLA S/STD SHORT

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270673213
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 POLYAXIAL LOCKING SCRE

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687834
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

GLENOID POLYAXIAL LOCKING SCRE

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687833
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

GLENOID POLYAXIAL LOCKING SCRE

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687833
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOID POLYAXIAL LOCKING SCRE

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687834
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOID POLYAX SCREW 30MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704873
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

GLENOID POLYAX SCREW 30MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704873
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOIDSPHERE 039X27

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270699526
Hospital Revenue Code	278
Min. Negotiated Rate	$504.10
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$6,745.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50
Rate for Payer: UnitedHealthcare Community & State	$560.90
Rate for Payer: Wellpoint Medicaid Managed Care	$504.10

GLENOIDSPHERE 039X27

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270699526
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOIDSPHERE 042X27

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270699525
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOIDSPHERE 042X27

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270699525
Hospital Revenue Code	278
Min. Negotiated Rate	$504.10
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$6,745.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50
Rate for Payer: UnitedHealthcare Community & State	$560.90
Rate for Payer: Wellpoint Medicaid Managed Care	$504.10

GLENOIDSPHERE 36X24.5

Facility

$125.00

Service Code	HCPCS C1776
Hospital Charge Code	270691236
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

GLENOIDSPHERE 36X24.5

Facility

$125.00

Service Code	HCPCS C1776
Hospital Charge Code	270691236
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

GLENOID TM MOD POST TI-6AI-4V

Facility

$8,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270699509
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.50
Max. Negotiated Rate	$2,011.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,662.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,011.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,246.50

GLENOID TM MOD POST TI-6AI-4V

Facility

$8,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270699509
Hospital Revenue Code	278
Min. Negotiated Rate	$236.00
Max. Negotiated Rate	$4,155.00
Rate for Payer: Aetna Commercial	$3,157.80
Rate for Payer: Aetna Medicare Advantage	$2,493.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,119.05
Rate for Payer: Cigna Commercial	$4,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,011.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,246.50
Rate for Payer: UnitedHealthcare Community & State	$262.60
Rate for Payer: Wellpoint Medicaid Managed Care	$236.00

Know your out-of-pocket cost for care.

All Charges