Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEAD FEMORAL ALLOGRAFT 77-0038

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270627380
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

HEAD FEMORAL ALLOGRAFT 77-0038

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270627380
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

HEAD FEMORAL CERAM BIOLOX 36MM

Facility

$10,220.00

Service Code	HCPCS C1776
Hospital Charge Code	270692213
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.00
Max. Negotiated Rate	$2,473.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,044.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,473.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.00

HEAD FEMORAL CERAM BIOLOX 36MM

Facility

$10,220.00

Service Code	HCPCS C1776
Hospital Charge Code	270692213
Hospital Revenue Code	278
Min. Negotiated Rate	$290.25
Max. Negotiated Rate	$5,110.00
Rate for Payer: Aetna Commercial	$3,883.60
Rate for Payer: Aetna Medicare Advantage	$3,066.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,606.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,606.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,606.10
Rate for Payer: Cigna Commercial	$5,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,473.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.00
Rate for Payer: UnitedHealthcare Community & State	$322.95
Rate for Payer: Wellpoint Medicaid Managed Care	$290.25

HEAD FEMORAL COCR 32MM +0 12/1

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270679647
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

HEAD FEMORAL COCR 32MM +0 12/1

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270679647
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

HEAD FEMORAL COCR 36MM +0

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270670573
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 COCR 36MM +0

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270670573
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 LFIT 22.2MM +0MM

Facility

$1,948.70

Service Code	HCPCS C1776
Hospital Charge Code	270681296
Hospital Revenue Code	278
Min. Negotiated Rate	$55.34
Max. Negotiated Rate	$974.35
Rate for Payer: Aetna Commercial	$740.51
Rate for Payer: Aetna Medicare Advantage	$584.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$496.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$496.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$496.92
Rate for Payer: Cigna Commercial	$974.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.59
Rate for Payer: Qualcare PPO/HMO/WC	$292.31
Rate for Payer: UnitedHealthcare Community & State	$61.58
Rate for Payer: Wellpoint Medicaid Managed Care	$55.34

HEAD FEMORAL LFIT 22.2MM +0MM

Facility

$1,948.70

Service Code	HCPCS C1776
Hospital Charge Code	270681296
Hospital Revenue Code	278
Min. Negotiated Rate	$292.31
Max. Negotiated Rate	$471.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.59
Rate for Payer: Qualcare PPO/HMO/WC	$292.31

HEAD FEMORAL LFIT 26MM -3MM

Facility

$2,030.70

Service Code	HCPCS C1776
Hospital Charge Code	270671303
Hospital Revenue Code	278
Min. Negotiated Rate	$304.61
Max. Negotiated Rate	$491.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$406.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$491.43
Rate for Payer: Qualcare PPO/HMO/WC	$304.61

HEAD FEMORAL LFIT 26MM -3MM

Facility

$2,030.70

Service Code	HCPCS C1776
Hospital Charge Code	270671303
Hospital Revenue Code	278
Min. Negotiated Rate	$57.67
Max. Negotiated Rate	$1,015.35
Rate for Payer: Aetna Commercial	$771.67
Rate for Payer: Aetna Medicare Advantage	$609.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$406.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$517.83
Rate for Payer: Cigna Commercial	$1,015.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$491.43
Rate for Payer: Qualcare PPO/HMO/WC	$304.61
Rate for Payer: UnitedHealthcare Community & State	$64.17
Rate for Payer: Wellpoint Medicaid Managed Care	$57.67

HEAD FEMORAL LFIT 26MM +4MM

Facility

$4,277.00

Service Code	HCPCS C1776
Hospital Charge Code	270683500
Hospital Revenue Code	278
Min. Negotiated Rate	$641.55
Max. Negotiated Rate	$1,035.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.03
Rate for Payer: Qualcare PPO/HMO/WC	$641.55

HEAD FEMORAL LFIT 26MM +4MM

Facility

$4,277.00

Service Code	HCPCS C1776
Hospital Charge Code	270683500
Hospital Revenue Code	278
Min. Negotiated Rate	$121.47
Max. Negotiated Rate	$2,138.50
Rate for Payer: Aetna Commercial	$1,625.26
Rate for Payer: Aetna Medicare Advantage	$1,283.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.63
Rate for Payer: Cigna Commercial	$2,138.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.03
Rate for Payer: Qualcare PPO/HMO/WC	$641.55
Rate for Payer: UnitedHealthcare Community & State	$135.15
Rate for Payer: Wellpoint Medicaid Managed Care	$121.47

HEAD FEMORAL LFIT 32MM +4MM

Facility

$4,033.25

Service Code	HCPCS C1776
Hospital Charge Code	270680445
Hospital Revenue Code	278
Min. Negotiated Rate	$604.99
Max. Negotiated Rate	$976.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$806.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$976.05
Rate for Payer: Qualcare PPO/HMO/WC	$604.99

HEAD FEMORAL LFIT 32MM +4MM

Facility

$4,033.25

Service Code	HCPCS C1776
Hospital Charge Code	270680445
Hospital Revenue Code	278
Min. Negotiated Rate	$114.54
Max. Negotiated Rate	$2,016.62
Rate for Payer: Aetna Commercial	$1,532.63
Rate for Payer: Aetna Medicare Advantage	$1,209.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$806.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.48
Rate for Payer: Cigna Commercial	$2,016.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$976.05
Rate for Payer: Qualcare PPO/HMO/WC	$604.99
Rate for Payer: UnitedHealthcare Community & State	$127.45
Rate for Payer: Wellpoint Medicaid Managed Care	$114.54

HEAD FEMORAL LFIT 36MM +0MM

Facility

$11,753.70

Service Code	HCPCS C1776
Hospital Charge Code	270677351
Hospital Revenue Code	278
Min. Negotiated Rate	$333.81
Max. Negotiated Rate	$5,876.85
Rate for Payer: Aetna Commercial	$4,466.41
Rate for Payer: Aetna Medicare Advantage	$3,526.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,997.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,997.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,997.19
Rate for Payer: Cigna Commercial	$5,876.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,844.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,763.06
Rate for Payer: UnitedHealthcare Community & State	$371.42
Rate for Payer: Wellpoint Medicaid Managed Care	$333.81

HEAD FEMORAL LFIT 36MM +0MM

Facility

$11,753.70

Service Code	HCPCS C1776
Hospital Charge Code	270677351
Hospital Revenue Code	278
Min. Negotiated Rate	$1,763.06
Max. Negotiated Rate	$2,844.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,844.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,763.06

HEAD FEMORAL SZ 0 28MM XXL

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680970
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 SZ 0 28MM XXL

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680970
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 SZ 26MM +0

Facility

$2,786.40

Service Code	HCPCS C1776
Hospital Charge Code	270673479
Hospital Revenue Code	278
Min. Negotiated Rate	$417.96
Max. Negotiated Rate	$674.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$557.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$674.31
Rate for Payer: Qualcare PPO/HMO/WC	$417.96

HEAD FEMORAL SZ 26MM +0

Facility

$2,786.40

Service Code	HCPCS C1776
Hospital Charge Code	270673479
Hospital Revenue Code	278
Min. Negotiated Rate	$79.13
Max. Negotiated Rate	$1,393.20
Rate for Payer: Aetna Commercial	$1,058.83
Rate for Payer: Aetna Medicare Advantage	$835.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$710.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$710.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$557.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$710.53
Rate for Payer: Cigna Commercial	$1,393.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$674.31
Rate for Payer: Qualcare PPO/HMO/WC	$417.96
Rate for Payer: UnitedHealthcare Community & State	$88.05
Rate for Payer: Wellpoint Medicaid Managed Care	$79.13

HEAD FEMORAL SZ 28MM +10MM

Facility

$2,171.75

Service Code	HCPCS C1776
Hospital Charge Code	270676939
Hospital Revenue Code	278
Min. Negotiated Rate	$325.76
Max. Negotiated Rate	$525.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$434.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.56
Rate for Payer: Qualcare PPO/HMO/WC	$325.76

HEAD FEMORAL SZ 28MM +10MM

Facility

$2,171.75

Service Code	HCPCS C1776
Hospital Charge Code	270676939
Hospital Revenue Code	278
Min. Negotiated Rate	$61.68
Max. Negotiated Rate	$1,085.88
Rate for Payer: Aetna Commercial	$825.26
Rate for Payer: Aetna Medicare Advantage	$651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$553.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$553.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$434.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$553.80
Rate for Payer: Cigna Commercial	$1,085.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.56
Rate for Payer: Qualcare PPO/HMO/WC	$325.76
Rate for Payer: UnitedHealthcare Community & State	$68.63
Rate for Payer: Wellpoint Medicaid Managed Care	$61.68

HEAD FEMORAL SZ M 22.2MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677710
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

Know your out-of-pocket cost for care.

All Charges