Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INSERT 12x71/75 183742

Facility

$3,750.00

Hospital Charge Code	270638692
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

INSERT 12x71/75 183742

Facility

$3,750.00

Hospital Charge Code	270638692
Hospital Revenue Code	272
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) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

INSERT AND REMOVE BONE PIN

Facility

$15,297.50

Service Code	HCPCS 20650
Hospital Charge Code	5701010
Hospital Revenue Code	450
Min. Negotiated Rate	$90.31
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,977.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,294.62
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$434.45

INSERT AND REMOVE BONE PIN

Facility

$15,297.50

Service Code	HCPCS 20650
Hospital Charge Code	5701010
Hospital Revenue Code	450
Min. Negotiated Rate	$2,294.62
Max. Negotiated Rate	$2,294.62
Rate for Payer: Qualcare PPO/HMO/WC	$2,294.62

INSERT BEARING THIATHLON SZ2

Facility

$5,182.10

Service Code	HCPCS C1776
Hospital Charge Code	270682133
Hospital Revenue Code	278
Min. Negotiated Rate	$147.17
Max. Negotiated Rate	$2,591.05
Rate for Payer: Aetna Commercial	$1,969.20
Rate for Payer: Aetna Medicare Advantage	$1,554.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,321.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,321.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,321.44
Rate for Payer: Cigna Commercial	$2,591.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.07
Rate for Payer: Qualcare PPO/HMO/WC	$777.32
Rate for Payer: UnitedHealthcare Community & State	$163.75
Rate for Payer: Wellpoint Medicaid Managed Care	$147.17

INSERT BEARING THIATHLON SZ2

Facility

$5,182.10

Service Code	HCPCS C1776
Hospital Charge Code	270682133
Hospital Revenue Code	278
Min. Negotiated Rate	$777.32
Max. Negotiated Rate	$1,254.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.07
Rate for Payer: Qualcare PPO/HMO/WC	$777.32

INSERT BEARING TIBIAL 6X11MM

Facility

$4,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270692133
Hospital Revenue Code	278
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$1,178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$974.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.54
Rate for Payer: Qualcare PPO/HMO/WC	$730.50

INSERT BEARING TIBIAL 6X11MM

Facility

$4,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270692133
Hospital Revenue Code	278
Min. Negotiated Rate	$138.31
Max. Negotiated Rate	$2,435.00
Rate for Payer: Aetna Commercial	$1,850.60
Rate for Payer: Aetna Medicare Advantage	$1,461.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,241.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,241.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$974.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,241.85
Rate for Payer: Cigna Commercial	$2,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.54
Rate for Payer: Qualcare PPO/HMO/WC	$730.50
Rate for Payer: UnitedHealthcare Community & State	$153.89
Rate for Payer: Wellpoint Medicaid Managed Care	$138.31

INSERT BEARING TIBIAL PS X3

Facility

$5,211.40

Service Code	HCPCS C1776
Hospital Charge Code	270691404
Hospital Revenue Code	278
Min. Negotiated Rate	$781.71
Max. Negotiated Rate	$1,261.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.16
Rate for Payer: Qualcare PPO/HMO/WC	$781.71

INSERT BEARING TIBIAL PS X3

Facility

$5,211.40

Service Code	HCPCS C1776
Hospital Charge Code	270691404
Hospital Revenue Code	278
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$2,605.70
Rate for Payer: Aetna Commercial	$1,980.33
Rate for Payer: Aetna Medicare Advantage	$1,563.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.91
Rate for Payer: Cigna Commercial	$2,605.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.16
Rate for Payer: Qualcare PPO/HMO/WC	$781.71
Rate for Payer: UnitedHealthcare Community & State	$164.68
Rate for Payer: Wellpoint Medicaid Managed Care	$148.00

INSERT BEARING TIBIAL SZ 6 13

Facility

$5,759.20

Service Code	HCPCS C1776
Hospital Charge Code	270691408
Hospital Revenue Code	278
Min. Negotiated Rate	$163.56
Max. Negotiated Rate	$2,879.60
Rate for Payer: Aetna Commercial	$2,188.50
Rate for Payer: Aetna Medicare Advantage	$1,727.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,468.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,468.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,151.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,468.60
Rate for Payer: Cigna Commercial	$2,879.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,393.73
Rate for Payer: Qualcare PPO/HMO/WC	$863.88
Rate for Payer: UnitedHealthcare Community & State	$181.99
Rate for Payer: Wellpoint Medicaid Managed Care	$163.56

INSERT BEARING TIBIAL SZ 6 13

Facility

$5,759.20

Service Code	HCPCS C1776
Hospital Charge Code	270691408
Hospital Revenue Code	278
Min. Negotiated Rate	$863.88
Max. Negotiated Rate	$1,393.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,151.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,393.73
Rate for Payer: Qualcare PPO/HMO/WC	$863.88

INSERT BEARING X3 TIBIAL

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691261
Hospital Revenue Code	278
Min. Negotiated Rate	$141.58
Max. Negotiated Rate	$2,492.62
Rate for Payer: Aetna Commercial	$1,894.39
Rate for Payer: Aetna Medicare Advantage	$1,495.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.24
Rate for Payer: Cigna Commercial	$2,492.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$157.53
Rate for Payer: Wellpoint Medicaid Managed Care	$141.58

INSERT BEARING X3 TIBIAL

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691261
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

INSERT BERING TIBIA SZ 3

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691268
Hospital Revenue Code	278
Min. Negotiated Rate	$141.58
Max. Negotiated Rate	$2,492.62
Rate for Payer: Aetna Commercial	$1,894.39
Rate for Payer: Aetna Medicare Advantage	$1,495.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.24
Rate for Payer: Cigna Commercial	$2,492.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$157.53
Rate for Payer: Wellpoint Medicaid Managed Care	$141.58

INSERT BERING TIBIA SZ 3

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691268
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

INSERT CATH PLEURA W IMAGE

Facility

$3,419.20

Service Code	HCPCS 32557
Hospital Charge Code	2101193
Hospital Revenue Code	361
Min. Negotiated Rate	$512.88
Max. Negotiated Rate	$512.88
Rate for Payer: Qualcare PPO/HMO/WC	$512.88

INSERT CATH PLEURA W IMAGE

Facility

$6,404.20

Service Code	HCPCS 32557
Hospital Charge Code	5701102
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

INSERT CATH PLEURA W IMAGE

Facility

$3,419.20

Service Code	HCPCS 32557
Hospital Charge Code	2101193
Hospital Revenue Code	361
Min. Negotiated Rate	$97.11
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$888.99
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$512.88
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$108.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$97.11

INSERT CATH PLEURA W IMAGE

Facility

$3,419.20

Service Code	HCPCS 32557
Hospital Charge Code	366832557
Hospital Revenue Code	361
Min. Negotiated Rate	$97.11
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$888.99
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$512.88
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$108.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$97.11

INSERT CATH PLEURA W IMAGE

Facility

$3,419.20

Service Code	HCPCS 32557
Hospital Charge Code	366832557
Hospital Revenue Code	361
Min. Negotiated Rate	$512.88
Max. Negotiated Rate	$512.88
Rate for Payer: Qualcare PPO/HMO/WC	$512.88

INSERT CATH PLEURA W IMAGE

Facility

$9,500.00

Service Code	HCPCS 32557
Hospital Charge Code	2250451
Hospital Revenue Code	361
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

INSERT CATH PLEURA W IMAGE

Facility

$6,404.20

Service Code	HCPCS 32557
Hospital Charge Code	321032557
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

INSERT CATH PLEURA W IMAGE

Facility

$9,500.00

Service Code	HCPCS 32557
Hospital Charge Code	2250451
Hospital Revenue Code	361
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

INSERT CATH PLEURA W IMAGE

Facility

$6,404.20

Service Code	HCPCS 32557
Hospital Charge Code	321032557
Hospital Revenue Code	361
Min. Negotiated Rate	$181.88
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,665.09
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$202.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$181.88

Know your out-of-pocket cost for care.

All Charges