Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HUMERAL REVRS METAPHYSIS 9MM0D

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699527
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

HUMERAL ROD 8X200MM

Facility

$10,245.00

Hospital Charge Code	270671057
Hospital Revenue Code	278
Min. Negotiated Rate	$290.96
Max. Negotiated Rate	$5,122.50
Rate for Payer: Aetna Commercial	$3,893.10
Rate for Payer: Aetna Medicare Advantage	$3,073.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,612.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,612.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,612.47
Rate for Payer: Cigna Commercial	$5,122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,479.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,536.75
Rate for Payer: UnitedHealthcare Community & State	$323.74
Rate for Payer: Wellpoint Medicaid Managed Care	$290.96

HUMERAL ROD 8X200MM

Facility

$10,245.00

Hospital Charge Code	270671057
Hospital Revenue Code	278
Min. Negotiated Rate	$1,536.75
Max. Negotiated Rate	$2,479.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,479.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,536.75

HUMERAL RVS HC LINER 32X3MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696737
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 RVS HC LINER 32X3MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696737
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 RVS HC LINER 32X6MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696738
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 RVS HC LINER 32X6MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696738
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 RVS METAPHYSIS 0MM 0D

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687836
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

HUMERAL RVS METAPHYSIS 0MM 0D

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687836
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

HUMERAL STEM #113637

Facility

$23,000.00

Hospital Charge Code	270702536
Hospital Revenue Code	278
Min. Negotiated Rate	$3,450.00
Max. Negotiated Rate	$5,566.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00

HUMERAL STEM #113637

Facility

$23,000.00

Hospital Charge Code	270702536
Hospital Revenue Code	278
Min. Negotiated Rate	$653.20
Max. Negotiated Rate	$11,500.00
Rate for Payer: Aetna Commercial	$8,740.00
Rate for Payer: Aetna Medicare Advantage	$6,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,865.00
Rate for Payer: Cigna Commercial	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00
Rate for Payer: UnitedHealthcare Community & State	$726.80
Rate for Payer: Wellpoint Medicaid Managed Care	$653.20

HUMERAL STEM LF 12.5MM

Facility

$9,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270684768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

HUMERAL STEM LF 12.5MM

Facility

$9,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270684768
Hospital Revenue Code	278
Min. Negotiated Rate	$260.43
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$3,484.60
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Community & State	$289.77
Rate for Payer: Wellpoint Medicaid Managed Care	$260.43

HUMERAL STEM LF 6.5MM

Facility

$20,025.00

Hospital Charge Code	270668549
Hospital Revenue Code	278
Min. Negotiated Rate	$568.71
Max. Negotiated Rate	$10,012.50
Rate for Payer: Aetna Commercial	$7,609.50
Rate for Payer: Aetna Medicare Advantage	$6,007.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,106.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,106.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,005.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,106.38
Rate for Payer: Cigna Commercial	$10,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,846.05
Rate for Payer: Qualcare PPO/HMO/WC	$3,003.75
Rate for Payer: UnitedHealthcare Community & State	$632.79
Rate for Payer: Wellpoint Medicaid Managed Care	$568.71

HUMERAL STEM LF 6.5MM

Facility

$20,025.00

Hospital Charge Code	270668549
Hospital Revenue Code	278
Min. Negotiated Rate	$3,003.75
Max. Negotiated Rate	$4,846.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,846.05
Rate for Payer: Qualcare PPO/HMO/WC	$3,003.75

HUMERAL STEM PRIMARY 11MM

Facility

$9,998.75

Service Code	HCPCS C1776
Hospital Charge Code	270669342
Hospital Revenue Code	278
Min. Negotiated Rate	$283.96
Max. Negotiated Rate	$4,999.38
Rate for Payer: Aetna Commercial	$3,799.53
Rate for Payer: Aetna Medicare Advantage	$2,999.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,549.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,549.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,999.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,549.68
Rate for Payer: Cigna Commercial	$4,999.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,419.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,499.81
Rate for Payer: UnitedHealthcare Community & State	$315.96
Rate for Payer: Wellpoint Medicaid Managed Care	$283.96

HUMERAL STEM PRIMARY 11MM

Facility

$9,998.75

Service Code	HCPCS C1776
Hospital Charge Code	270669342
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.81
Max. Negotiated Rate	$2,419.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,999.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,419.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,499.81

HUMERAL STEM PRIMARY 13MM

Facility

$9,169.85

Service Code	HCPCS C1776
Hospital Charge Code	270669658
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.48
Max. Negotiated Rate	$2,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48

HUMERAL STEM PRIMARY 13MM

Facility

$9,169.85

Service Code	HCPCS C1776
Hospital Charge Code	270669658
Hospital Revenue Code	278
Min. Negotiated Rate	$260.42
Max. Negotiated Rate	$4,584.93
Rate for Payer: Aetna Commercial	$3,484.54
Rate for Payer: Aetna Medicare Advantage	$2,750.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.31
Rate for Payer: Cigna Commercial	$4,584.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48
Rate for Payer: UnitedHealthcare Community & State	$289.77
Rate for Payer: Wellpoint Medicaid Managed Care	$260.42

HUMERAL STEM PRIMARY 17MM

Facility

$9,169.85

Hospital Charge Code	270675722
Hospital Revenue Code	278
Min. Negotiated Rate	$260.42
Max. Negotiated Rate	$4,584.93
Rate for Payer: Aetna Commercial	$3,484.54
Rate for Payer: Aetna Medicare Advantage	$2,750.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.31
Rate for Payer: Cigna Commercial	$4,584.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48
Rate for Payer: UnitedHealthcare Community & State	$289.77
Rate for Payer: Wellpoint Medicaid Managed Care	$260.42

HUMERAL STEM PRIMARY 17MM

Facility

$9,169.85

Hospital Charge Code	270675722
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.48
Max. Negotiated Rate	$2,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48

HUMERAL STEM PRM PRESS FIT 9MM

Facility

$9,169.85

Service Code	HCPCS C1776
Hospital Charge Code	270673290
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.48
Max. Negotiated Rate	$2,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48

HUMERAL STEM PRM PRESS FIT 9MM

Facility

$9,169.85

Service Code	HCPCS C1776
Hospital Charge Code	270673290
Hospital Revenue Code	278
Min. Negotiated Rate	$260.42
Max. Negotiated Rate	$4,584.93
Rate for Payer: Aetna Commercial	$3,484.54
Rate for Payer: Aetna Medicare Advantage	$2,750.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,833.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.31
Rate for Payer: Cigna Commercial	$4,584.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.48
Rate for Payer: UnitedHealthcare Community & State	$289.77
Rate for Payer: Wellpoint Medicaid Managed Care	$260.42

HUMERAL STEM RIGHT 10.5MM

Facility

$20,025.00

Hospital Charge Code	270668560
Hospital Revenue Code	278
Min. Negotiated Rate	$3,003.75
Max. Negotiated Rate	$4,846.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,846.05
Rate for Payer: Qualcare PPO/HMO/WC	$3,003.75

HUMERAL STEM RIGHT 10.5MM

Facility

$20,025.00

Hospital Charge Code	270668560
Hospital Revenue Code	278
Min. Negotiated Rate	$568.71
Max. Negotiated Rate	$10,012.50
Rate for Payer: Aetna Commercial	$7,609.50
Rate for Payer: Aetna Medicare Advantage	$6,007.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,106.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,106.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,005.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,106.38
Rate for Payer: Cigna Commercial	$10,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,846.05
Rate for Payer: Qualcare PPO/HMO/WC	$3,003.75
Rate for Payer: UnitedHealthcare Community & State	$632.79
Rate for Payer: Wellpoint Medicaid Managed Care	$568.71

Know your out-of-pocket cost for care.

All Charges