Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEAD BIPOL SC 28MM ID/52MM OD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699294
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

HEAD BIP SELF CEM 28MM 40MM OD

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691719
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

HEAD BIP SELF CEM 28MM 40MM OD

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691719
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

HEAD BIXCUT MOD REAMER 10.5MM

Facility

$2,610.00

Hospital Charge Code	270670462
Hospital Revenue Code	272
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.60
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$82.48
Rate for Payer: Wellpoint Medicaid Managed Care	$74.12

HEAD BIXCUT MOD REAMER 10.5MM

Facility

$2,610.00

Hospital Charge Code	270670462
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 10MM

Facility

$2,610.00

Hospital Charge Code	270670461
Hospital Revenue Code	272
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.60
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$82.48
Rate for Payer: Wellpoint Medicaid Managed Care	$74.12

HEAD BIXCUT MOD REAMER 10MM

Facility

$2,610.00

Hospital Charge Code	270670461
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 11.5MM

Facility

$2,610.00

Hospital Charge Code	270670464
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 11.5MM

Facility

$2,610.00

Hospital Charge Code	270670464
Hospital Revenue Code	272
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.60
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$82.48
Rate for Payer: Wellpoint Medicaid Managed Care	$74.12

HEAD BIXCUT MOD REAMER 11MM

Facility

$2,610.00

Hospital Charge Code	270670463
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 11MM

Facility

$2,610.00

Hospital Charge Code	270670463
Hospital Revenue Code	272
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.60
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$82.48
Rate for Payer: Wellpoint Medicaid Managed Care	$74.12

HEAD BIXCUT MOD REAMER 9.5MM

Facility

$2,610.00

Hospital Charge Code	270670460
Hospital Revenue Code	272
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.60
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$82.48
Rate for Payer: Wellpoint Medicaid Managed Care	$74.12

HEAD BIXCUT MOD REAMER 9.5MM

Facility

$2,610.00

Hospital Charge Code	270670460
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 9MM

Facility

$2,610.00

Hospital Charge Code	270670459
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 9MM

Facility

$2,610.00

Hospital Charge Code	270670459
Hospital Revenue Code	272
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$678.60
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$82.48
Rate for Payer: Wellpoint Medicaid Managed Care	$74.12

HEAD BMT MOD 28 6 163660

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270607276
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

HEAD BMT MOD 28 6 163660

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270607276
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

HEAD CERC 40 16/18 TAP 6501058

Facility

$11,040.00

Service Code	HCPCS C1776
Hospital Charge Code	270644874
Hospital Revenue Code	278
Min. Negotiated Rate	$313.54
Max. Negotiated Rate	$5,520.00
Rate for Payer: Aetna Commercial	$4,195.20
Rate for Payer: Aetna Medicare Advantage	$3,312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,815.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,815.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,208.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,815.20
Rate for Payer: Cigna Commercial	$5,520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,671.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,656.00
Rate for Payer: UnitedHealthcare Community & State	$348.86
Rate for Payer: Wellpoint Medicaid Managed Care	$313.54

HEAD CERC 40 16/18 TAP 6501058

Facility

$11,040.00

Service Code	HCPCS C1776
Hospital Charge Code	270644874
Hospital Revenue Code	278
Min. Negotiated Rate	$1,656.00
Max. Negotiated Rate	$2,671.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,208.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,671.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,656.00

HEAD COCR M 36M

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681920
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

HEAD COCR M 36M

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681920
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

HEAD COMP ENDOPROSTHESIS 42MM

Facility

$4,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270674000
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

HEAD COMP ENDOPROSTHESIS 42MM

Facility

$4,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270674000
Hospital Revenue Code	278
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$130.35
Rate for Payer: Wellpoint Medicaid Managed Care	$117.15

HEAD COMP ENDOPROSTHESIS 43MM

Facility

$4,252.25

Service Code	HCPCS C1776
Hospital Charge Code	270678036
Hospital Revenue Code	278
Min. Negotiated Rate	$120.76
Max. Negotiated Rate	$2,126.12
Rate for Payer: Aetna Commercial	$1,615.86
Rate for Payer: Aetna Medicare Advantage	$1,275.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,084.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,084.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,084.32
Rate for Payer: Cigna Commercial	$2,126.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.04
Rate for Payer: Qualcare PPO/HMO/WC	$637.84
Rate for Payer: UnitedHealthcare Community & State	$134.37
Rate for Payer: Wellpoint Medicaid Managed Care	$120.76

HEAD COMP ENDOPROSTHESIS 43MM

Facility

$4,252.25

Service Code	HCPCS C1776
Hospital Charge Code	270678036
Hospital Revenue Code	278
Min. Negotiated Rate	$637.84
Max. Negotiated Rate	$1,029.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.04
Rate for Payer: Qualcare PPO/HMO/WC	$637.84

Know your out-of-pocket cost for care.

All Charges