Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HUMERAL STEM STANDARD SZ 11

Facility

$23,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270700221
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 STANDARD SZ 11

Facility

$23,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270700221
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 STD SHORTSZ3

Facility

$47,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270700532
Hospital Revenue Code	278
Min. Negotiated Rate	$7,180.50
Max. Negotiated Rate	$11,584.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,584.54
Rate for Payer: Qualcare PPO/HMO/WC	$7,180.50

HUMERAL STEM STD SHORTSZ3

Facility

$47,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270700532
Hospital Revenue Code	278
Min. Negotiated Rate	$1,359.51
Max. Negotiated Rate	$23,935.00
Rate for Payer: Aetna Commercial	$18,190.60
Rate for Payer: Aetna Medicare Advantage	$14,361.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,206.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,206.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,206.85
Rate for Payer: Cigna Commercial	$23,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,584.54
Rate for Payer: Qualcare PPO/HMO/WC	$7,180.50
Rate for Payer: UnitedHealthcare Community & State	$1,512.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,359.51

HUMERAL TRAY #110031406

Facility

$10,500.00

Hospital Charge Code	270702533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

HUMERAL TRAY #110031406

Facility

$10,500.00

Hospital Charge Code	270702533
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

HUMERAL TRAY +5 44MM

Facility

$7,500.00

Hospital Charge Code	270671258
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

HUMERAL TRAY +5 44MM

Facility

$7,500.00

Hospital Charge Code	270671258
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

HUMERAL X3 INSERT 36x2MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270671583
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

HUMERAL X3 INSERT 36x2MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270671583
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

HUMER DIAPH SH CEMENTLESS SZ9

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693055
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

HUMER DIAPH SH CEMENTLESS SZ9

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693055
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

HUMER DIAPHY SHORT NO CEMENT 8

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270696753
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

HUMER DIAPHY SHORT NO CEMENT 8

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270696753
Hospital Revenue Code	278
Min. Negotiated Rate	$504.10
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$6,745.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50
Rate for Payer: UnitedHealthcare Community & State	$560.90
Rate for Payer: Wellpoint Medicaid Managed Care	$504.10

HUMERUS 2 VIEWS-LT

Facility

$5,100.00

Service Code	HCPCS 73060LT
Hospital Charge Code	94061293
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HUMERUS 2 VIEWS-LT

Facility

$5,100.00

Service Code	HCPCS 73060LT
Hospital Charge Code	94061293
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

HUMERUS 2 VIEWS-RT

Facility

$5,100.00

Service Code	HCPCS 73060RT
Hospital Charge Code	94061295
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

HUMERUS 2 VIEWS-RT

Facility

$5,100.00

Service Code	HCPCS 73060RT
Hospital Charge Code	94061295
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HUMIDIFIER OXYGEN 500 ML

Facility

$6.96

Hospital Charge Code	270625161
Hospital Revenue Code	270
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.04

HUMIDIFIER OXYGEN 500 ML

Facility

$6.96

Hospital Charge Code	270625161
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.48
Rate for Payer: Aetna Commercial	$2.64
Rate for Payer: Aetna Medicare Advantage	$2.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.77
Rate for Payer: Cigna Commercial	$3.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.81
Rate for Payer: Oxford Commercial	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.04
Rate for Payer: UnitedHealthcare Commercial	$1.39
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

HUMIDIFIER OXYGEN STERILE H20

Facility

$5.50

Hospital Charge Code	270369531
Hospital Revenue Code	270
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

HUMIDIFIER OXYGEN STERILE H20

Facility

$5.50

Hospital Charge Code	270369531
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$2.09
Rate for Payer: Aetna Medicare Advantage	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.40
Rate for Payer: Cigna Commercial	$2.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.43
Rate for Payer: Oxford Commercial	$1.10
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Commercial	$1.10
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

HUMIDIF OXYG 500ml L.FRE M0352

Facility

$7.50

Hospital Charge Code	270639700
Hospital Revenue Code	270
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

HUMIDIF OXYG 500ml L.FRE M0352

Facility

$7.50

Hospital Charge Code	270639700
Hospital Revenue Code	270
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.50
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

HUM METAPHYS CMNTLS 135A 7 DEG

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686874
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