Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INSERT PSN RVCK ART SUR VE18MM

Facility

$12,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270700044
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.75
Max. Negotiated Rate	$3,123.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,581.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,123.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.75

INSERT/REPLACE PG DU

Facility

$31,274.00

Service Code	HCPCS 33228
Hospital Charge Code	366833228
Hospital Revenue Code	480
Min. Negotiated Rate	$4,691.10
Max. Negotiated Rate	$4,691.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,691.10

INSERT/REPLACE PG DU

Facility

$31,274.00

Service Code	HCPCS 33228
Hospital Charge Code	366833228
Hospital Revenue Code	480
Min. Negotiated Rate	$213.72
Max. Negotiated Rate	$45,043.57
Rate for Payer: Aetna Commercial	$33,774.92
Rate for Payer: Aetna Medicare Advantage	$40,231.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,043.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,043.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,417.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$213.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45,043.57
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: Cigna Medicare Advantage	$12,417.25
Rate for Payer: Clover Medicare Advantage	$11,796.39
Rate for Payer: EmblemHealth Commercial	$37,251.75
Rate for Payer: Humana Medicare Advantage	$12,789.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,417.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,131.24
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,691.10
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$988.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare Medicare Advantage	$12,417.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,126.04
Rate for Payer: Wellpoint Medicaid Managed Care	$888.18

INSERT/REPLACE PG SN

Facility

$27,653.00

Service Code	HCPCS 33212
Hospital Charge Code	366833212
Hospital Revenue Code	480
Min. Negotiated Rate	$4,147.95
Max. Negotiated Rate	$4,147.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,147.95

INSERT/REPLACE PG SN

Facility

$27,653.00

Service Code	HCPCS 33212
Hospital Charge Code	366833212
Hospital Revenue Code	480
Min. Negotiated Rate	$218.41
Max. Negotiated Rate	$35,663.33
Rate for Payer: Aetna Commercial	$26,741.35
Rate for Payer: Aetna Medicare Advantage	$31,853.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,663.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,663.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,831.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$218.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,663.33
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: Cigna Medicare Advantage	$9,831.38
Rate for Payer: Clover Medicare Advantage	$9,339.81
Rate for Payer: EmblemHealth Commercial	$29,494.14
Rate for Payer: Humana Medicare Advantage	$10,126.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,831.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,189.78
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,147.95
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$873.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,831.38
Rate for Payer: Wellcare Medicare Advantage	$9,831.38
Rate for Payer: Wellpoint Medicaid Managed Care	$785.35

INSERT SELF CONTD PROSTHESIS

Facility

$94,818.00

Service Code	HCPCS 54401
Hospital Charge Code	1600000543
Hospital Revenue Code	360
Min. Negotiated Rate	$14,222.70
Max. Negotiated Rate	$14,222.70
Rate for Payer: Qualcare PPO/HMO/WC	$14,222.70

INSERT SELF CONTD PROSTHESIS

Facility

$94,818.00

Service Code	HCPCS 54401
Hospital Charge Code	1600000543
Hospital Revenue Code	360
Min. Negotiated Rate	$2,692.83
Max. Negotiated Rate	$89,320.59
Rate for Payer: Aetna Commercial	$66,975.05
Rate for Payer: Aetna Medicare Advantage	$79,779.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89,320.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89,320.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,623.18
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	$89,320.59
Rate for Payer: Cigna Commercial	$49,357.08
Rate for Payer: Cigna Medicare Advantage	$24,623.18
Rate for Payer: Clover Medicare Advantage	$23,392.02
Rate for Payer: EmblemHealth Commercial	$73,869.54
Rate for Payer: Humana Medicare Advantage	$25,361.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,623.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,652.68
Rate for Payer: Oxford Commercial	$15,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$14,222.70
Rate for Payer: UnitedHealthcare Commercial	$17,348.00
Rate for Payer: UnitedHealthcare Community & State	$2,996.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,623.18
Rate for Payer: Wellcare Medicare Advantage	$24,623.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2,692.83

INSERT SHOULDER RET

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270689836
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

INSERT SHOULDER RET

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270689836
Hospital Revenue Code	278
Min. Negotiated Rate	$146.26
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,957.00
Rate for Payer: Aetna Medicare Advantage	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.25
Rate for Payer: Cigna Commercial	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50
Rate for Payer: UnitedHealthcare Community & State	$162.74
Rate for Payer: Wellpoint Medicaid Managed Care	$146.26

INSERT SHOULDER RET 3 MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270687800
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

INSERT SHOULDER RET 3 MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270687800
Hospital Revenue Code	278
Min. Negotiated Rate	$146.26
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,957.00
Rate for Payer: Aetna Medicare Advantage	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.25
Rate for Payer: Cigna Commercial	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50
Rate for Payer: UnitedHealthcare Community & State	$162.74
Rate for Payer: Wellpoint Medicaid Managed Care	$146.26

INSERT SHOULDER RET. +5MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270684267
Hospital Revenue Code	278
Min. Negotiated Rate	$146.26
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,957.00
Rate for Payer: Aetna Medicare Advantage	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.25
Rate for Payer: Cigna Commercial	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50
Rate for Payer: UnitedHealthcare Community & State	$162.74
Rate for Payer: Wellpoint Medicaid Managed Care	$146.26

INSERT SHOULDER RET. +5MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270684267
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

INSERT SHPERE FLEX LEFT 10MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684049
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

INSERT SHPERE FLEX LEFT 10MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684049
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX 14MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681367
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX 14MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681367
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

INSERT SPHERE FLEX 14 MM S2 LE

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684073
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX 14 MM S2 LE

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684073
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

INSERT SPHERE FLEX 20 MM S3 L

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684074
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX 20 MM S3 L

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684074
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

INSERT SPHERE FLEX L 12MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683384
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT SPHERE FLEX L 12MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683384
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

INSERT SPHERE FLEX L 13MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681285
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

INSERT SPHERE FLEX L 13MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681285
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

Know your out-of-pocket cost for care.

All Charges