Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEAD FEM DELTA BIOLOX 28MM

Facility

$6,410.00

Service Code	HCPCS C1776
Hospital Charge Code	270700045
Hospital Revenue Code	278
Min. Negotiated Rate	$182.04
Max. Negotiated Rate	$3,205.00
Rate for Payer: Aetna Commercial	$2,435.80
Rate for Payer: Aetna Medicare Advantage	$1,923.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,634.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,634.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,282.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,634.55
Rate for Payer: Cigna Commercial	$3,205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.22
Rate for Payer: Qualcare PPO/HMO/WC	$961.50
Rate for Payer: UnitedHealthcare Community & State	$202.56
Rate for Payer: Wellpoint Medicaid Managed Care	$182.04

HEAD FEMORAL 26MM +8MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270673427
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$865.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

HEAD FEMORAL 26MM +8MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270673427
Hospital Revenue Code	278
Min. Negotiated Rate	$101.53
Max. Negotiated Rate	$1,787.50
Rate for Payer: Aetna Commercial	$1,358.50
Rate for Payer: Aetna Medicare Advantage	$1,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$911.62
Rate for Payer: Cigna Commercial	$1,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: Qualcare PPO/HMO/WC	$536.25
Rate for Payer: UnitedHealthcare Community & State	$112.97
Rate for Payer: Wellpoint Medicaid Managed Care	$101.53

HEAD FEMORAL 28mm +0mm

Facility

$4,271.30

Service Code	HCPCS C1776
Hospital Charge Code	270676689
Hospital Revenue Code	278
Min. Negotiated Rate	$121.30
Max. Negotiated Rate	$2,135.65
Rate for Payer: Aetna Commercial	$1,623.09
Rate for Payer: Aetna Medicare Advantage	$1,281.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,089.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,089.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$854.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,089.18
Rate for Payer: Cigna Commercial	$2,135.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,033.65
Rate for Payer: Qualcare PPO/HMO/WC	$640.70
Rate for Payer: UnitedHealthcare Community & State	$134.97
Rate for Payer: Wellpoint Medicaid Managed Care	$121.30

HEAD FEMORAL 28mm +0mm

Facility

$4,271.30

Service Code	HCPCS C1776
Hospital Charge Code	270676689
Hospital Revenue Code	278
Min. Negotiated Rate	$640.70
Max. Negotiated Rate	$1,033.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$854.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,033.65
Rate for Payer: Qualcare PPO/HMO/WC	$640.70

HEAD FEMORAL 28MM +5

Facility

$2,610.00

Hospital Charge Code	270677210
Hospital Revenue Code	278
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) NJ Health	$522.00
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	$631.62
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Community & State	$82.48
Rate for Payer: Wellpoint Medicaid Managed Care	$74.12

HEAD FEMORAL 28MM +5

Facility

$2,610.00

Hospital Charge Code	270677210
Hospital Revenue Code	278
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$631.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$522.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$631.62
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD FEMORAL 28MM LARGE

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677987
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 FEMORAL 28MM LARGE

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677987
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 FEMORAL 32MM +0MM

Facility

$4,143.00

Service Code	HCPCS C1776
Hospital Charge Code	270680957
Hospital Revenue Code	278
Min. Negotiated Rate	$621.45
Max. Negotiated Rate	$1,002.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$828.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,002.61
Rate for Payer: Qualcare PPO/HMO/WC	$621.45

HEAD FEMORAL 32MM +0MM

Facility

$4,143.00

Service Code	HCPCS C1776
Hospital Charge Code	270680957
Hospital Revenue Code	278
Min. Negotiated Rate	$117.66
Max. Negotiated Rate	$2,071.50
Rate for Payer: Aetna Commercial	$1,574.34
Rate for Payer: Aetna Medicare Advantage	$1,242.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,056.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,056.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$828.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,056.46
Rate for Payer: Cigna Commercial	$2,071.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,002.61
Rate for Payer: Qualcare PPO/HMO/WC	$621.45
Rate for Payer: UnitedHealthcare Community & State	$130.92
Rate for Payer: Wellpoint Medicaid Managed Care	$117.66

HEAD FEMORAL 36-50mm

Facility

$9,044.75

Service Code	HCPCS C1776
Hospital Charge Code	270678864
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.71
Max. Negotiated Rate	$2,188.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.71

HEAD FEMORAL 36-50mm

Facility

$9,044.75

Service Code	HCPCS C1776
Hospital Charge Code	270678864
Hospital Revenue Code	278
Min. Negotiated Rate	$256.87
Max. Negotiated Rate	$4,522.38
Rate for Payer: Aetna Commercial	$3,437.01
Rate for Payer: Aetna Medicare Advantage	$2,713.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,306.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,306.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,306.41
Rate for Payer: Cigna Commercial	$4,522.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.71
Rate for Payer: UnitedHealthcare Community & State	$285.81
Rate for Payer: Wellpoint Medicaid Managed Care	$256.87

HEAD FEMORAL 36MM

Facility

$4,250.00

Hospital Charge Code	270703305
Hospital Revenue Code	278
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$134.30
Rate for Payer: Wellpoint Medicaid Managed Care	$120.70

HEAD FEMORAL 36MM

Facility

$4,250.00

Hospital Charge Code	270703305
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

HEAD FEMORAL 36MM

Facility

$8,498.00

Service Code	HCPCS C1776
Hospital Charge Code	270678672
Hospital Revenue Code	278
Min. Negotiated Rate	$1,274.70
Max. Negotiated Rate	$2,056.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,699.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,056.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,274.70

HEAD FEMORAL 36MM

Facility

$8,498.00

Service Code	HCPCS C1776
Hospital Charge Code	270678672
Hospital Revenue Code	278
Min. Negotiated Rate	$241.34
Max. Negotiated Rate	$4,249.00
Rate for Payer: Aetna Commercial	$3,229.24
Rate for Payer: Aetna Medicare Advantage	$2,549.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,166.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,166.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,699.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,166.99
Rate for Payer: Cigna Commercial	$4,249.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,056.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,274.70
Rate for Payer: UnitedHealthcare Community & State	$268.54
Rate for Payer: Wellpoint Medicaid Managed Care	$241.34

HEAD FEMORAL 36MM +0MM

Facility

$4,087.15

Service Code	HCPCS C1776
Hospital Charge Code	270679973
Hospital Revenue Code	278
Min. Negotiated Rate	$613.07
Max. Negotiated Rate	$989.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$817.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.09
Rate for Payer: Qualcare PPO/HMO/WC	$613.07

HEAD FEMORAL 36MM +0MM

Facility

$4,087.15

Service Code	HCPCS C1776
Hospital Charge Code	270679973
Hospital Revenue Code	278
Min. Negotiated Rate	$116.08
Max. Negotiated Rate	$2,043.58
Rate for Payer: Aetna Commercial	$1,553.12
Rate for Payer: Aetna Medicare Advantage	$1,226.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,042.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,042.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$817.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,042.22
Rate for Payer: Cigna Commercial	$2,043.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.09
Rate for Payer: Qualcare PPO/HMO/WC	$613.07
Rate for Payer: UnitedHealthcare Community & State	$129.15
Rate for Payer: Wellpoint Medicaid Managed Care	$116.08

HEAD FEMORAL 36MM -2.5MM

Facility

$4,728.50

Service Code	HCPCS C1776
Hospital Charge Code	270676583
Hospital Revenue Code	278
Min. Negotiated Rate	$709.27
Max. Negotiated Rate	$1,144.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$945.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.30
Rate for Payer: Qualcare PPO/HMO/WC	$709.27

HEAD FEMORAL 36MM -2.5MM

Facility

$4,728.50

Service Code	HCPCS C1776
Hospital Charge Code	270676583
Hospital Revenue Code	278
Min. Negotiated Rate	$134.29
Max. Negotiated Rate	$2,364.25
Rate for Payer: Aetna Commercial	$1,796.83
Rate for Payer: Aetna Medicare Advantage	$1,418.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,205.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,205.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$945.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,205.77
Rate for Payer: Cigna Commercial	$2,364.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.30
Rate for Payer: Qualcare PPO/HMO/WC	$709.27
Rate for Payer: UnitedHealthcare Community & State	$149.42
Rate for Payer: Wellpoint Medicaid Managed Care	$134.29

HEAD FEMORAL 36MM +5MM

Facility

$4,182.30

Service Code	HCPCS C1776
Hospital Charge Code	270677486
Hospital Revenue Code	278
Min. Negotiated Rate	$627.35
Max. Negotiated Rate	$1,012.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$836.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,012.12
Rate for Payer: Qualcare PPO/HMO/WC	$627.35

HEAD FEMORAL 36MM +5MM

Facility

$4,182.30

Service Code	HCPCS C1776
Hospital Charge Code	270677486
Hospital Revenue Code	278
Min. Negotiated Rate	$118.78
Max. Negotiated Rate	$2,091.15
Rate for Payer: Aetna Commercial	$1,589.27
Rate for Payer: Aetna Medicare Advantage	$1,254.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,066.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,066.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$836.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,066.49
Rate for Payer: Cigna Commercial	$2,091.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,012.12
Rate for Payer: Qualcare PPO/HMO/WC	$627.35
Rate for Payer: UnitedHealthcare Community & State	$132.16
Rate for Payer: Wellpoint Medicaid Managed Care	$118.78

HEAD FEMORAL 3x28MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677118
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

HEAD FEMORAL 3x28MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677118
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

Know your out-of-pocket cost for care.

All Charges