Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 M 28MM

Facility

$2,500.00

Hospital Charge Code	270677709
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 FEMORAL SZ M 28MM

Facility

$2,500.00

Hospital Charge Code	270677709
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 FEMORAL TAPER 32MM

Facility

$15,640.00

Service Code	HCPCS C1776
Hospital Charge Code	270696295
Hospital Revenue Code	278
Min. Negotiated Rate	$444.18
Max. Negotiated Rate	$7,820.00
Rate for Payer: Aetna Commercial	$5,943.20
Rate for Payer: Aetna Medicare Advantage	$4,692.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,988.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,988.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,128.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,988.20
Rate for Payer: Cigna Commercial	$7,820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,784.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.00
Rate for Payer: UnitedHealthcare Community & State	$494.22
Rate for Payer: Wellpoint Medicaid Managed Care	$444.18

HEAD FEMORAL TAPER 32MM

Facility

$15,640.00

Service Code	HCPCS C1776
Hospital Charge Code	270696295
Hospital Revenue Code	278
Min. Negotiated Rate	$2,346.00
Max. Negotiated Rate	$3,784.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,784.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.00

HEAD FEMORAL V40 28mm +8mm

Facility

$2,132.95

Service Code	HCPCS C1776
Hospital Charge Code	270685585
Hospital Revenue Code	278
Min. Negotiated Rate	$319.94
Max. Negotiated Rate	$516.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$516.17
Rate for Payer: Qualcare PPO/HMO/WC	$319.94

HEAD FEMORAL V40 28mm +8mm

Facility

$2,132.95

Service Code	HCPCS C1776
Hospital Charge Code	270685585
Hospital Revenue Code	278
Min. Negotiated Rate	$60.58
Max. Negotiated Rate	$1,066.47
Rate for Payer: Aetna Commercial	$810.52
Rate for Payer: Aetna Medicare Advantage	$639.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.90
Rate for Payer: Cigna Commercial	$1,066.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$516.17
Rate for Payer: Qualcare PPO/HMO/WC	$319.94
Rate for Payer: UnitedHealthcare Community & State	$67.40
Rate for Payer: Wellpoint Medicaid Managed Care	$60.58

HEAD FEMORAL V40 LFIT 22.2MM3D

Facility

$1,741.00

Service Code	HCPCS C1776
Hospital Charge Code	270695079
Hospital Revenue Code	278
Min. Negotiated Rate	$261.15
Max. Negotiated Rate	$421.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$348.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.32
Rate for Payer: Qualcare PPO/HMO/WC	$261.15

HEAD FEMORAL V40 LFIT 22.2MM3D

Facility

$1,741.00

Service Code	HCPCS C1776
Hospital Charge Code	270695079
Hospital Revenue Code	278
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$870.50
Rate for Payer: Aetna Commercial	$661.58
Rate for Payer: Aetna Medicare Advantage	$522.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$443.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$443.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$348.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$443.95
Rate for Payer: Cigna Commercial	$870.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.32
Rate for Payer: Qualcare PPO/HMO/WC	$261.15
Rate for Payer: UnitedHealthcare Community & State	$55.02
Rate for Payer: Wellpoint Medicaid Managed Care	$49.44

HEAD FEMORAL VERSYS 3.5X28MM

Facility

$3,239.60

Service Code	HCPCS C1776
Hospital Charge Code	270605655
Hospital Revenue Code	278
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$1,619.80
Rate for Payer: Aetna Commercial	$1,231.05
Rate for Payer: Aetna Medicare Advantage	$971.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$826.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$826.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$647.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$826.10
Rate for Payer: Cigna Commercial	$1,619.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.98
Rate for Payer: Qualcare PPO/HMO/WC	$485.94
Rate for Payer: UnitedHealthcare Community & State	$102.37
Rate for Payer: Wellpoint Medicaid Managed Care	$92.00

HEAD FEMORAL VERSYS 3.5X28MM

Facility

$3,239.60

Service Code	HCPCS C1776
Hospital Charge Code	270605655
Hospital Revenue Code	278
Min. Negotiated Rate	$485.94
Max. Negotiated Rate	$783.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$647.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.98
Rate for Payer: Qualcare PPO/HMO/WC	$485.94

HEAD FEMOR BIOLOX OPTION 40MM

Facility

$11,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270698184
Hospital Revenue Code	278
Min. Negotiated Rate	$1,710.00
Max. Negotiated Rate	$2,758.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00

HEAD FEMOR BIOLOX OPTION 40MM

Facility

$11,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270698184
Hospital Revenue Code	278
Min. Negotiated Rate	$323.76
Max. Negotiated Rate	$5,700.00
Rate for Payer: Aetna Commercial	$4,332.00
Rate for Payer: Aetna Medicare Advantage	$3,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,907.00
Rate for Payer: Cigna Commercial	$5,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00
Rate for Payer: UnitedHealthcare Community & State	$360.24
Rate for Payer: Wellpoint Medicaid Managed Care	$323.76

HEAD FEM UHR BIPOLAR 28X44MM

Facility

$5,833.30

Service Code	HCPCS C1776
Hospital Charge Code	270697699
Hospital Revenue Code	278
Min. Negotiated Rate	$165.67
Max. Negotiated Rate	$2,916.65
Rate for Payer: Aetna Commercial	$2,216.65
Rate for Payer: Aetna Medicare Advantage	$1,749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,487.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,487.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,487.49
Rate for Payer: Cigna Commercial	$2,916.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,411.66
Rate for Payer: Qualcare PPO/HMO/WC	$875.00
Rate for Payer: UnitedHealthcare Community & State	$184.33
Rate for Payer: Wellpoint Medicaid Managed Care	$165.67

HEAD FEM UHR BIPOLAR 28X44MM

Facility

$5,833.30

Service Code	HCPCS C1776
Hospital Charge Code	270697699
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$1,411.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,411.66
Rate for Payer: Qualcare PPO/HMO/WC	$875.00

HEAD FEMUR COCR HD 28X3.5

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270700084
Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$747.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: Qualcare PPO/HMO/WC	$463.12

HEAD FEMUR COCR HD 28X3.5

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270700084
Hospital Revenue Code	278
Min. Negotiated Rate	$87.69
Max. Negotiated Rate	$1,543.75
Rate for Payer: Aetna Commercial	$1,173.25
Rate for Payer: Aetna Medicare Advantage	$926.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$787.31
Rate for Payer: Cigna Commercial	$1,543.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: Qualcare PPO/HMO/WC	$463.12
Rate for Payer: UnitedHealthcare Community & State	$97.56
Rate for Payer: Wellpoint Medicaid Managed Care	$87.69

HEAD FEMUR COMP CMPL SZ 4

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270694675
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

HEAD FEMUR COMP CMPL SZ 4

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270694675
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

HEAD FERMORAL COCR 36mm -6mm

Facility

$3,005.00

Hospital Charge Code	270640066
Hospital Revenue Code	278
Min. Negotiated Rate	$85.34
Max. Negotiated Rate	$1,502.50
Rate for Payer: Aetna Commercial	$1,141.90
Rate for Payer: Aetna Medicare Advantage	$901.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$766.27
Rate for Payer: Cigna Commercial	$1,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75
Rate for Payer: UnitedHealthcare Community & State	$94.96
Rate for Payer: Wellpoint Medicaid Managed Care	$85.34

HEAD FERMORAL COCR 36mm -6mm

Facility

$3,005.00

Hospital Charge Code	270640066
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$727.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

HEAD FOR FEMORAL HEAD IMPACTOR

Facility

$350.00

Hospital Charge Code	270673263
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

HEAD FOR FEMORAL HEAD IMPACTOR

Facility

$350.00

Hospital Charge Code	270673263
Hospital Revenue Code	272
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

HEAD GLENO TM REVERSE 36MM 0D

Facility

$6,847.50

Service Code	HCPCS C1776
Hospital Charge Code	270696093
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.12
Max. Negotiated Rate	$1,657.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,369.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.12

HEAD GLENO TM REVERSE 36MM 0D

Facility

$6,847.50

Service Code	HCPCS C1776
Hospital Charge Code	270696093
Hospital Revenue Code	278
Min. Negotiated Rate	$194.47
Max. Negotiated Rate	$3,423.75
Rate for Payer: Aetna Commercial	$2,602.05
Rate for Payer: Aetna Medicare Advantage	$2,054.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,369.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.11
Rate for Payer: Cigna Commercial	$3,423.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,657.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.12
Rate for Payer: UnitedHealthcare Community & State	$216.38
Rate for Payer: Wellpoint Medicaid Managed Care	$194.47

Know your out-of-pocket cost for care.

All Charges