Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT HIGH PROFILE 550CC

Facility

$4,635.00

Hospital Charge Code	669962
Hospital Revenue Code	278
Min. Negotiated Rate	$131.63
Max. Negotiated Rate	$2,317.50
Rate for Payer: Aetna Commercial	$1,761.30
Rate for Payer: Aetna Medicare Advantage	$1,390.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,181.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,181.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,181.92
Rate for Payer: Cigna Commercial	$2,317.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,121.67
Rate for Payer: Qualcare PPO/HMO/WC	$695.25
Rate for Payer: UnitedHealthcare Community & State	$146.47
Rate for Payer: Wellpoint Medicaid Managed Care	$131.63

IMPLANT HIGH PROFILE 600CC

Facility

$3,750.00

Hospital Charge Code	270669963
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

IMPLANT HIGH PROFILE 600CC

Facility

$3,750.00

Hospital Charge Code	270669963
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 700CC

Facility

$3,750.00

Hospital Charge Code	270670917
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 700CC

Facility

$3,750.00

Hospital Charge Code	270670917
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

IMPLANT HIGH PROFILE 750CC

Facility

$3,750.00

Hospital Charge Code	270670918
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

IMPLANT HIGH PROFILE 750CC

Facility

$3,750.00

Hospital Charge Code	270670918
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT HIGH PROFILE 800CC

Facility

$3,750.00

Hospital Charge Code	270670919
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

IMPLANT HIGH PROFILE 800CC

Facility

$3,750.00

Hospital Charge Code	270670919
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT - HIP REVISION

Facility

$25,261.00

Hospital Charge Code	270335634
Hospital Revenue Code	278
Min. Negotiated Rate	$717.41
Max. Negotiated Rate	$12,630.50
Rate for Payer: Aetna Commercial	$9,599.18
Rate for Payer: Aetna Medicare Advantage	$7,578.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,441.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,441.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,052.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,441.56
Rate for Payer: Cigna Commercial	$12,630.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,113.16
Rate for Payer: Qualcare PPO/HMO/WC	$3,789.15
Rate for Payer: UnitedHealthcare Community & State	$798.25
Rate for Payer: Wellpoint Medicaid Managed Care	$717.41

IMPLANT - HIP REVISION

Facility

$25,261.00

Hospital Charge Code	270335634
Hospital Revenue Code	278
Min. Negotiated Rate	$3,789.15
Max. Negotiated Rate	$6,113.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,052.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,113.16
Rate for Payer: Qualcare PPO/HMO/WC	$3,789.15

IMPLANT IFUSE 7.0MMX 40MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685122
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

IMPLANT IFUSE 7.0MMX 40MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685122
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

IMPLANT IFUSE 7.0MMX 45MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685121
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

IMPLANT IFUSE 7.0MMX 45MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685121
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

IMPLANT IFUSE 7.0MMX 55MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685120
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

IMPLANT IFUSE 7.0MMX 55MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685120
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

IMPLANT IFUSE 7.0X60MM

Facility

$17,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270696619
Hospital Revenue Code	278
Min. Negotiated Rate	$495.01
Max. Negotiated Rate	$8,715.00
Rate for Payer: Aetna Commercial	$6,623.40
Rate for Payer: Aetna Medicare Advantage	$5,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,444.65
Rate for Payer: Cigna Commercial	$8,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50
Rate for Payer: UnitedHealthcare Community & State	$550.79
Rate for Payer: Wellpoint Medicaid Managed Care	$495.01

IMPLANT IFUSE 7.0X60MM

Facility

$17,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270696619
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$4,218.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IMPLANT KIT 9x7x7mm

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675247
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

IMPLANT KIT 9x7x7mm

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675247
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

IMPLANT LAT 18X12X50MM 10DEG

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694531
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

IMPLANT LAT 18X12X50MM 10DEG

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694531
Hospital Revenue Code	278
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$924.30
Rate for Payer: Wellpoint Medicaid Managed Care	$830.70

IMPLANT-MANDIBULAR FRACTURE

Facility

$7,500.00

Hospital Charge Code	270335478
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

IMPLANT-MANDIBULAR FRACTURE

Facility

$7,500.00

Hospital Charge Code	270335478
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

Know your out-of-pocket cost for care.

All Charges