Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AMISTEM-H CTD SZ1 CMNTLSS COLL

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678452
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM-H CTD SZ3 CMNTLSS COLL

Facility

$11,480.00

Service Code	HCPCS C1776
Hospital Charge Code	270677985
Hospital Revenue Code	278
Min. Negotiated Rate	$326.03
Max. Negotiated Rate	$5,740.00
Rate for Payer: Aetna Commercial	$4,362.40
Rate for Payer: Aetna Medicare Advantage	$3,444.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,927.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,927.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,927.40
Rate for Payer: Cigna Commercial	$5,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,778.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,722.00
Rate for Payer: UnitedHealthcare Community & State	$362.77
Rate for Payer: Wellpoint Medicaid Managed Care	$326.03

AMISTEM-H CTD SZ3 CMNTLSS COLL

Facility

$11,480.00

Service Code	HCPCS C1776
Hospital Charge Code	270677985
Hospital Revenue Code	278
Min. Negotiated Rate	$1,722.00
Max. Negotiated Rate	$2,778.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,296.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,778.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,722.00

AMISTEM-H CTD SZ4 CMNTLSS COLL

Facility

$10,000.00

Hospital Charge Code	270678092
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

AMISTEM-H CTD SZ4 CMNTLSS COLL

Facility

$10,000.00

Hospital Charge Code	270678092
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

AMISTEM-H CTD SZ5 CMNTLSS COLL

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680057
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMISTEM-H CTD SZ5 CMNTLSS COLL

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680057
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM-H CTD SZ6 CEMENTLESS

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681088
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM-H CTD SZ6 CEMENTLESS

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681088
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMISTEM-H CTD SZ7 CEMENTLESS

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682089
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM-H CTD SZ7 CEMENTLESS

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682089
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMISTEM-H CTD SZ7 CMNTLSS

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681949
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM-H CTD SZ7 CMNTLSS

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681949
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMISTEM-H FEM. LAT. SZ4 CMNTLS

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678794
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM-H FEM. LAT. SZ4 CMNTLS

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678794
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMISTEM H STANDARD #5

Facility

$11,480.00

Service Code	HCPCS C1776
Hospital Charge Code	270677945
Hospital Revenue Code	278
Min. Negotiated Rate	$326.03
Max. Negotiated Rate	$5,740.00
Rate for Payer: Aetna Commercial	$4,362.40
Rate for Payer: Aetna Medicare Advantage	$3,444.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,927.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,927.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,927.40
Rate for Payer: Cigna Commercial	$5,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,778.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,722.00
Rate for Payer: UnitedHealthcare Community & State	$362.77
Rate for Payer: Wellpoint Medicaid Managed Care	$326.03

AMISTEM H STANDARD #5

Facility

$11,480.00

Service Code	HCPCS C1776
Hospital Charge Code	270677945
Hospital Revenue Code	278
Min. Negotiated Rate	$1,722.00
Max. Negotiated Rate	$2,778.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,296.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,778.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,722.00

AMISTEM-P COLLARED STD SZ 6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270696468
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM-P COLLARED STD SZ 6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270696468
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMI STEM-P STD # 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687142
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMI STEM-P STD # 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687142
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMISTEM P STD SZ 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM P STD SZ 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686146
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMI STEM STD SIZE 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669778
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMI STEM STD SIZE 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669778
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

Know your out-of-pocket cost for care.

All Charges