Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEAD COMP ENDOPROSTHESIS 48MM

Facility

$4,125.00

Hospital Charge Code	270669749
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 48MM

Facility

$4,125.00

Hospital Charge Code	270669749
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 FEM ENDOPROSTH 47MM

Facility

$4,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270693839
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 FEM ENDOPROSTH 47MM

Facility

$4,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270693839
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 CRCO 46X18 HUMELOCK CEM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270692131
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

HEAD CRCO 46X18 HUMELOCK CEM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270692131
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

HEAD DELTA 40MM L BIOLOX

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684312
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 DELTA 40MM L BIOLOX

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684312
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 DELTA CERAMIC V40 28MM

Facility

$3,416.95

Service Code	HCPCS C1776
Hospital Charge Code	270699504
Hospital Revenue Code	278
Min. Negotiated Rate	$97.04
Max. Negotiated Rate	$1,708.47
Rate for Payer: Aetna Commercial	$1,298.44
Rate for Payer: Aetna Medicare Advantage	$1,025.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$683.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.32
Rate for Payer: Cigna Commercial	$1,708.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.90
Rate for Payer: Qualcare PPO/HMO/WC	$512.54
Rate for Payer: UnitedHealthcare Community & State	$107.98
Rate for Payer: Wellpoint Medicaid Managed Care	$97.04

HEAD DELTA CERAMIC V40 28MM

Facility

$3,416.95

Service Code	HCPCS C1776
Hospital Charge Code	270699504
Hospital Revenue Code	278
Min. Negotiated Rate	$512.54
Max. Negotiated Rate	$826.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$683.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.90
Rate for Payer: Qualcare PPO/HMO/WC	$512.54

HEAD DELTA C-TAPER 32MM -2.5MM

Facility

$4,255.50

Service Code	HCPCS C1776
Hospital Charge Code	270693032
Hospital Revenue Code	278
Min. Negotiated Rate	$120.86
Max. Negotiated Rate	$2,127.75
Rate for Payer: Aetna Commercial	$1,617.09
Rate for Payer: Aetna Medicare Advantage	$1,276.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,085.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,085.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$851.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,085.15
Rate for Payer: Cigna Commercial	$2,127.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.83
Rate for Payer: Qualcare PPO/HMO/WC	$638.33
Rate for Payer: UnitedHealthcare Community & State	$134.47
Rate for Payer: Wellpoint Medicaid Managed Care	$120.86

HEAD DELTA C-TAPER 32MM -2.5MM

Facility

$4,255.50

Service Code	HCPCS C1776
Hospital Charge Code	270693032
Hospital Revenue Code	278
Min. Negotiated Rate	$638.33
Max. Negotiated Rate	$1,029.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$851.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.83
Rate for Payer: Qualcare PPO/HMO/WC	$638.33

HEAD DELTA MED 36mm BIOLOX LT

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270682864
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 DELTA MED 36mm BIOLOX LT

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270682864
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

HEADED DARCO 6.5x50MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270683636
Hospital Revenue Code	278
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$55.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.70

HEADED DARCO 6.5x50MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270683636
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

HEAD FEM 28MM +3.5MM BOPLOX

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270695088
Hospital Revenue Code	278
Min. Negotiated Rate	$283.72
Max. Negotiated Rate	$4,995.00
Rate for Payer: Aetna Commercial	$3,796.20
Rate for Payer: Aetna Medicare Advantage	$2,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,547.45
Rate for Payer: Cigna Commercial	$4,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50
Rate for Payer: UnitedHealthcare Community & State	$315.68
Rate for Payer: Wellpoint Medicaid Managed Care	$283.72

HEAD FEM 28MM +3.5MM BOPLOX

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270695088
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.50
Max. Negotiated Rate	$2,417.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50

HEAD FEM BIOLOX DELTA CER 28MM

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270694799
Hospital Revenue Code	278
Min. Negotiated Rate	$283.72
Max. Negotiated Rate	$4,995.00
Rate for Payer: Aetna Commercial	$3,796.20
Rate for Payer: Aetna Medicare Advantage	$2,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,547.45
Rate for Payer: Cigna Commercial	$4,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50
Rate for Payer: UnitedHealthcare Community & State	$315.68
Rate for Payer: Wellpoint Medicaid Managed Care	$283.72

HEAD FEM BIOLOX DELTA CER 28MM

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270694799
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.50
Max. Negotiated Rate	$2,417.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50

HEADFEMBIOLOXDLT12/14TAP36MM

Facility

$8,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270697655
Hospital Revenue Code	278
Min. Negotiated Rate	$239.55
Max. Negotiated Rate	$4,217.50
Rate for Payer: Aetna Commercial	$3,205.30
Rate for Payer: Aetna Medicare Advantage	$2,530.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,150.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,150.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,150.93
Rate for Payer: Cigna Commercial	$4,217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.25
Rate for Payer: UnitedHealthcare Community & State	$266.55
Rate for Payer: Wellpoint Medicaid Managed Care	$239.55

HEADFEMBIOLOXDLT12/14TAP36MM

Facility

$8,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270697655
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.25
Max. Negotiated Rate	$2,041.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.25

HEAD FEM CER BIOLOX DELTA 36MM

Facility

$17,434.35

Service Code	HCPCS C1776
Hospital Charge Code	270698838
Hospital Revenue Code	278
Min. Negotiated Rate	$2,615.15
Max. Negotiated Rate	$4,219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,219.11
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.15

HEAD FEM CER BIOLOX DELTA 36MM

Facility

$17,434.35

Service Code	HCPCS C1776
Hospital Charge Code	270698838
Hospital Revenue Code	278
Min. Negotiated Rate	$495.14
Max. Negotiated Rate	$8,717.17
Rate for Payer: Aetna Commercial	$6,625.05
Rate for Payer: Aetna Medicare Advantage	$5,230.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,445.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,445.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,445.76
Rate for Payer: Cigna Commercial	$8,717.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,219.11
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.15
Rate for Payer: UnitedHealthcare Community & State	$550.93
Rate for Payer: Wellpoint Medicaid Managed Care	$495.14

HEAD FEM DELTA BIOLOX 28MM

Facility

$6,410.00

Service Code	HCPCS C1776
Hospital Charge Code	270700045
Hospital Revenue Code	278
Min. Negotiated Rate	$961.50
Max. Negotiated Rate	$1,551.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,282.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.22
Rate for Payer: Qualcare PPO/HMO/WC	$961.50

Know your out-of-pocket cost for care.

All Charges