Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT SHORTEN MET SLOT 2.7

Facility

$2,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270701869
Hospital Revenue Code	278
Min. Negotiated Rate	$447.75
Max. Negotiated Rate	$722.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$597.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$722.37
Rate for Payer: Qualcare PPO/HMO/WC	$447.75

IMPLANT SHORTEN MET SLOT 2.7

Facility

$2,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270701869
Hospital Revenue Code	278
Min. Negotiated Rate	$84.77
Max. Negotiated Rate	$1,492.50
Rate for Payer: Aetna Commercial	$1,134.30
Rate for Payer: Aetna Medicare Advantage	$895.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$597.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.17
Rate for Payer: Cigna Commercial	$1,492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$722.37
Rate for Payer: Qualcare PPO/HMO/WC	$447.75
Rate for Payer: UnitedHealthcare Community & State	$94.33
Rate for Payer: Wellpoint Medicaid Managed Care	$84.77

IMPLANT SMALL 10 DEG ANGLED

Facility

$5,390.00

Hospital Charge Code	270675709
Hospital Revenue Code	278
Min. Negotiated Rate	$808.50
Max. Negotiated Rate	$1,304.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,078.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,304.38
Rate for Payer: Qualcare PPO/HMO/WC	$808.50

IMPLANT SMALL 10 DEG ANGLED

Facility

$5,390.00

Hospital Charge Code	270675709
Hospital Revenue Code	278
Min. Negotiated Rate	$153.08
Max. Negotiated Rate	$2,695.00
Rate for Payer: Aetna Commercial	$2,048.20
Rate for Payer: Aetna Medicare Advantage	$1,617.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,374.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,374.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,078.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,374.45
Rate for Payer: Cigna Commercial	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,304.38
Rate for Payer: Qualcare PPO/HMO/WC	$808.50
Rate for Payer: UnitedHealthcare Community & State	$170.32
Rate for Payer: Wellpoint Medicaid Managed Care	$153.08

IMPLANT SOFT TISSUE RESTORE

Facility

$11,259.25

Service Code	HCPCS C1763
Hospital Charge Code	270633427
Hospital Revenue Code	278
Min. Negotiated Rate	$319.76
Max. Negotiated Rate	$5,629.62
Rate for Payer: Aetna Commercial	$4,278.52
Rate for Payer: Aetna Medicare Advantage	$3,377.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,871.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,871.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,251.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,871.11
Rate for Payer: Cigna Commercial	$5,629.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,724.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,688.89
Rate for Payer: UnitedHealthcare Community & State	$355.79
Rate for Payer: Wellpoint Medicaid Managed Care	$319.76

IMPLANT SOFT TISSUE RESTORE

Facility

$11,259.25

Service Code	HCPCS C1763
Hospital Charge Code	270633427
Hospital Revenue Code	278
Min. Negotiated Rate	$1,688.89
Max. Negotiated Rate	$2,724.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,251.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,724.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,688.89

IMPLANT SYS HIP LABRAL RECON

Facility

$9,835.00

Service Code	HCPCS C1713
Hospital Charge Code	270691620
Hospital Revenue Code	278
Min. Negotiated Rate	$1,475.25
Max. Negotiated Rate	$2,380.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,967.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,475.25

IMPLANT SYS HIP LABRAL RECON

Facility

$9,835.00

Service Code	HCPCS C1713
Hospital Charge Code	270691620
Hospital Revenue Code	278
Min. Negotiated Rate	$279.31
Max. Negotiated Rate	$4,917.50
Rate for Payer: Aetna Commercial	$3,737.30
Rate for Payer: Aetna Medicare Advantage	$2,950.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,507.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,507.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,967.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,507.93
Rate for Payer: Cigna Commercial	$4,917.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,475.25
Rate for Payer: UnitedHealthcare Community & State	$310.79
Rate for Payer: Wellpoint Medicaid Managed Care	$279.31

IMPLANT SYS KIT PROX TENODESIS

Facility

$3,375.00

Service Code	HCPCS C1776
Hospital Charge Code	270673597
Hospital Revenue Code	278
Min. Negotiated Rate	$95.85
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Community & State	$106.65
Rate for Payer: Wellpoint Medicaid Managed Care	$95.85

IMPLANT SYS KIT PROX TENODESIS

Facility

$3,375.00

Service Code	HCPCS C1776
Hospital Charge Code	270673597
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$816.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

IMPLANT SYS MPFL BIO-COMPOSITE

Facility

$7,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270669427
Hospital Revenue Code	278
Min. Negotiated Rate	$1,115.25
Max. Negotiated Rate	$1,799.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,487.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,799.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,115.25

IMPLANT SYS MPFL BIO-COMPOSITE

Facility

$7,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270669427
Hospital Revenue Code	278
Min. Negotiated Rate	$211.15
Max. Negotiated Rate	$3,717.50
Rate for Payer: Aetna Commercial	$2,825.30
Rate for Payer: Aetna Medicare Advantage	$2,230.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,895.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,895.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,487.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,895.92
Rate for Payer: Cigna Commercial	$3,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,799.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,115.25
Rate for Payer: UnitedHealthcare Community & State	$234.95
Rate for Payer: Wellpoint Medicaid Managed Care	$211.15

IMPLANT SYS MPFL W/TIGHTROPE

Facility

$8,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270675206
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.25
Max. Negotiated Rate	$2,041.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.25

IMPLANT SYS MPFL W/TIGHTROPE

Facility

$8,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270675206
Hospital Revenue Code	278
Min. Negotiated Rate	$239.55
Max. Negotiated Rate	$4,217.50
Rate for Payer: Aetna Commercial	$3,205.30
Rate for Payer: Aetna Medicare Advantage	$2,530.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,150.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,150.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,150.93
Rate for Payer: Cigna Commercial	$4,217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.25
Rate for Payer: UnitedHealthcare Community & State	$266.55
Rate for Payer: Wellpoint Medicaid Managed Care	$239.55

IMPLANT SYS SPDBRG 4.75x19.1M

Facility

$7,025.00

Hospital Charge Code	270675507
Hospital Revenue Code	272
Min. Negotiated Rate	$199.51
Max. Negotiated Rate	$3,512.50
Rate for Payer: Aetna Commercial	$2,669.50
Rate for Payer: Aetna Medicare Advantage	$2,107.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,791.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,791.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,791.38
Rate for Payer: Cigna Commercial	$3,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,826.50
Rate for Payer: Oxford Commercial	$1,405.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,053.75
Rate for Payer: UnitedHealthcare Commercial	$1,405.00
Rate for Payer: UnitedHealthcare Community & State	$221.99
Rate for Payer: Wellpoint Medicaid Managed Care	$199.51

IMPLANT SYS SPDBRG 4.75x19.1M

Facility

$7,025.00

Hospital Charge Code	270675507
Hospital Revenue Code	272
Min. Negotiated Rate	$1,053.75
Max. Negotiated Rate	$1,053.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,053.75

IMPLANT SYS SPDBRG 4.75x19.1MM

Facility

$8,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270675255
Hospital Revenue Code	278
Min. Negotiated Rate	$1,305.00
Max. Negotiated Rate	$2,105.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,105.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,305.00

IMPLANT SYS SPDBRG 4.75x19.1MM

Facility

$8,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270675255
Hospital Revenue Code	278
Min. Negotiated Rate	$247.08
Max. Negotiated Rate	$4,350.00
Rate for Payer: Aetna Commercial	$3,306.00
Rate for Payer: Aetna Medicare Advantage	$2,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,740.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,218.50
Rate for Payer: Cigna Commercial	$4,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,105.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,305.00
Rate for Payer: UnitedHealthcare Community & State	$274.92
Rate for Payer: Wellpoint Medicaid Managed Care	$247.08

IMPLANT SYSTEM ACHILLES SPDBRG

Facility

$4,850.00

Hospital Charge Code	270675708
Hospital Revenue Code	272
Min. Negotiated Rate	$727.50
Max. Negotiated Rate	$727.50
Rate for Payer: Qualcare PPO/HMO/WC	$727.50

IMPLANT SYSTEM ACHILLES SPDBRG

Facility

$4,850.00

Hospital Charge Code	270675708
Hospital Revenue Code	272
Min. Negotiated Rate	$137.74
Max. Negotiated Rate	$2,425.00
Rate for Payer: Aetna Commercial	$1,843.00
Rate for Payer: Aetna Medicare Advantage	$1,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,236.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,236.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,236.75
Rate for Payer: Cigna Commercial	$2,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.00
Rate for Payer: Oxford Commercial	$970.00
Rate for Payer: Qualcare PPO/HMO/WC	$727.50
Rate for Payer: UnitedHealthcare Commercial	$970.00
Rate for Payer: UnitedHealthcare Community & State	$153.26
Rate for Payer: Wellpoint Medicaid Managed Care	$137.74

IMPLANT SYSTEM FIBERTAG IIFOR

Facility

$6,743.75

Service Code	HCPCS C1713
Hospital Charge Code	270704450
Hospital Revenue Code	278
Min. Negotiated Rate	$191.52
Max. Negotiated Rate	$3,371.88
Rate for Payer: Aetna Commercial	$2,562.62
Rate for Payer: Aetna Medicare Advantage	$2,023.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,719.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,719.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,719.66
Rate for Payer: Cigna Commercial	$3,371.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.56
Rate for Payer: UnitedHealthcare Community & State	$213.10
Rate for Payer: Wellpoint Medicaid Managed Care	$191.52

IMPLANT SYSTEM FIBERTAG IIFOR

Facility

$6,743.75

Service Code	HCPCS C1713
Hospital Charge Code	270704450
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.56
Max. Negotiated Rate	$1,631.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.56

IMPLANT SYSTEM LAT ANKLE RECON

Facility

$8,750.00

Hospital Charge Code	270684370
Hospital Revenue Code	278
Min. Negotiated Rate	$248.50
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$276.50
Rate for Payer: Wellpoint Medicaid Managed Care	$248.50

IMPLANT SYSTEM LAT ANKLE RECON

Facility

$8,750.00

Hospital Charge Code	270684370
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

IMPLANT SYSTEM PARS SUTURE

Facility

$3,750.00

Hospital Charge Code	270682350
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

Know your out-of-pocket cost for care.

All Charges