Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HUMERAL HEAD DIA. 48MM

Facility

$4,800.00

Service Code	HCPCS C1776
Hospital Charge Code	270675414
Hospital Revenue Code	278
Min. Negotiated Rate	$136.32
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,824.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00
Rate for Payer: UnitedHealthcare Community & State	$151.68
Rate for Payer: Wellpoint Medicaid Managed Care	$136.32

HUMERAL HEAD DIA. 48MM

Facility

$4,800.00

Service Code	HCPCS C1776
Hospital Charge Code	270675414
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

HUMERAL HEAD EXPANDED 47MM

Facility

$7,725.00

Hospital Charge Code	270669868
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$1,869.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

HUMERAL HEAD EXPANDED 47MM

Facility

$7,725.00

Hospital Charge Code	270669868
Hospital Revenue Code	278
Min. Negotiated Rate	$219.39
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$2,935.50
Rate for Payer: Aetna Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,969.88
Rate for Payer: Cigna Commercial	$3,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75
Rate for Payer: UnitedHealthcare Community & State	$244.11
Rate for Payer: Wellpoint Medicaid Managed Care	$219.39

HUMERAL HEAD TALL 41X20MM

Facility

$7,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270670756
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$1,869.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

HUMERAL HEAD TALL 41X20MM

Facility

$7,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270670756
Hospital Revenue Code	278
Min. Negotiated Rate	$219.39
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$2,935.50
Rate for Payer: Aetna Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,969.88
Rate for Payer: Cigna Commercial	$3,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75
Rate for Payer: UnitedHealthcare Community & State	$244.11
Rate for Payer: Wellpoint Medicaid Managed Care	$219.39

HUMERAL HEAD TALL 50MM

Facility

$7,725.00

Hospital Charge Code	270675724
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$1,869.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

HUMERAL HEAD TALL 50MM

Facility

$7,725.00

Hospital Charge Code	270675724
Hospital Revenue Code	278
Min. Negotiated Rate	$219.39
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$2,935.50
Rate for Payer: Aetna Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,969.88
Rate for Payer: Cigna Commercial	$3,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75
Rate for Payer: UnitedHealthcare Community & State	$244.11
Rate for Payer: Wellpoint Medicaid Managed Care	$219.39

HUMERAL INSERT RVRS SZ3/436MM

Facility

$20,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270700533
Hospital Revenue Code	278
Min. Negotiated Rate	$3,105.00
Max. Negotiated Rate	$5,009.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,009.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,105.00

HUMERAL INSERT RVRS SZ3/436MM

Facility

$20,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270700533
Hospital Revenue Code	278
Min. Negotiated Rate	$587.88
Max. Negotiated Rate	$10,350.00
Rate for Payer: Aetna Commercial	$7,866.00
Rate for Payer: Aetna Medicare Advantage	$6,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,278.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,278.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,278.50
Rate for Payer: Cigna Commercial	$10,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,009.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,105.00
Rate for Payer: UnitedHealthcare Community & State	$654.12
Rate for Payer: Wellpoint Medicaid Managed Care	$587.88

HUMERAL MIDDLE SEGMENT 25MM

Facility

$47,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679730
Hospital Revenue Code	278
Min. Negotiated Rate	$7,125.00
Max. Negotiated Rate	$11,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,495.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,125.00

HUMERAL MIDDLE SEGMENT 25MM

Facility

$47,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679730
Hospital Revenue Code	278
Min. Negotiated Rate	$1,349.00
Max. Negotiated Rate	$23,750.00
Rate for Payer: Aetna Commercial	$18,050.00
Rate for Payer: Aetna Medicare Advantage	$14,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,112.50
Rate for Payer: Cigna Commercial	$23,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,495.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,125.00
Rate for Payer: UnitedHealthcare Community & State	$1,501.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,349.00

HUMERAL MINI 10 MMX 83MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688026
Hospital Revenue Code	278
Min. Negotiated Rate	$2,175.00
Max. Negotiated Rate	$3,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00

HUMERAL MINI 10 MMX 83MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688026
Hospital Revenue Code	278
Min. Negotiated Rate	$411.80
Max. Negotiated Rate	$7,250.00
Rate for Payer: Aetna Commercial	$5,510.00
Rate for Payer: Aetna Medicare Advantage	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,697.50
Rate for Payer: Cigna Commercial	$7,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00
Rate for Payer: UnitedHealthcare Community & State	$458.20
Rate for Payer: Wellpoint Medicaid Managed Care	$411.80

HUMERAL NAIL T2 PRX LF 8X240MM

Facility

$14,690.00

Hospital Charge Code	270671182
Hospital Revenue Code	278
Min. Negotiated Rate	$2,203.50
Max. Negotiated Rate	$3,554.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,938.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,554.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,203.50

HUMERAL NAIL T2 PRX LF 8X240MM

Facility

$14,690.00

Hospital Charge Code	270671182
Hospital Revenue Code	278
Min. Negotiated Rate	$417.20
Max. Negotiated Rate	$7,345.00
Rate for Payer: Aetna Commercial	$5,582.20
Rate for Payer: Aetna Medicare Advantage	$4,407.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,745.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,745.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,938.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,745.95
Rate for Payer: Cigna Commercial	$7,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,554.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,203.50
Rate for Payer: UnitedHealthcare Community & State	$464.20
Rate for Payer: Wellpoint Medicaid Managed Care	$417.20

HUMERAL PE HC LINER 30.0MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699730
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

HUMERAL PE HC LINER 30.0MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699730
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

HUMERAL PROX BDY COMPSRS 48MM

Facility

$22,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270697380
Hospital Revenue Code	278
Min. Negotiated Rate	$3,438.00
Max. Negotiated Rate	$5,546.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,584.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,546.64
Rate for Payer: Qualcare PPO/HMO/WC	$3,438.00

HUMERAL PROX BDY COMPSRS 48MM

Facility

$22,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270697380
Hospital Revenue Code	278
Min. Negotiated Rate	$650.93
Max. Negotiated Rate	$11,460.00
Rate for Payer: Aetna Commercial	$8,709.60
Rate for Payer: Aetna Medicare Advantage	$6,876.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,844.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,844.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,844.60
Rate for Payer: Cigna Commercial	$11,460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,546.64
Rate for Payer: Qualcare PPO/HMO/WC	$3,438.00
Rate for Payer: UnitedHealthcare Community & State	$724.27
Rate for Payer: Wellpoint Medicaid Managed Care	$650.93

HUMERAL REVERSE HC LINER A 36/

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687837
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

HUMERAL REVERSE HC LINER A 36/

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687837
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

HUMERAL REVRS HC LINER 039X3MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699528
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

HUMERAL REVRS HC LINER 039X3MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699528
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

HUMERAL REVRS METAPHYSIS 9MM0D

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699527
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

Know your out-of-pocket cost for care.

All Charges