Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MODULAR CUP NEUTRAL 56X36

Facility

$6,220.00

Hospital Charge Code	270667176
Hospital Revenue Code	278
Min. Negotiated Rate	$933.00
Max. Negotiated Rate	$1,505.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: Qualcare PPO/HMO/WC	$933.00

MODULAR CUP TM 56MM MULTI H

Facility

$8,660.00

Hospital Charge Code	270667175
Hospital Revenue Code	278
Min. Negotiated Rate	$245.94
Max. Negotiated Rate	$4,330.00
Rate for Payer: Aetna Commercial	$3,290.80
Rate for Payer: Aetna Medicare Advantage	$2,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.30
Rate for Payer: Cigna Commercial	$4,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00
Rate for Payer: UnitedHealthcare Community & State	$273.66
Rate for Payer: Wellpoint Medicaid Managed Care	$245.94

MODULAR CUP TM 56MM MULTI H

Facility

$8,660.00

Hospital Charge Code	270667175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.00
Max. Negotiated Rate	$2,095.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00

MODULAR CUP TM 58MM MULTI H

Facility

$8,660.00

Hospital Charge Code	270667172
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.00
Max. Negotiated Rate	$2,095.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00

MODULAR CUP TM 58MM MULTI H

Facility

$8,660.00

Hospital Charge Code	270667172
Hospital Revenue Code	278
Min. Negotiated Rate	$245.94
Max. Negotiated Rate	$4,330.00
Rate for Payer: Aetna Commercial	$3,290.80
Rate for Payer: Aetna Medicare Advantage	$2,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.30
Rate for Payer: Cigna Commercial	$4,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00
Rate for Payer: UnitedHealthcare Community & State	$273.66
Rate for Payer: Wellpoint Medicaid Managed Care	$245.94

MODULAR HEAD 46MM

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

MODULAR HEAD 46MM

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675297
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$355.50
Rate for Payer: Wellpoint Medicaid Managed Care	$319.50

MODULAR HEAD CONSTRAIN 36/-6mm

Facility

$8,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270665221
Hospital Revenue Code	278
Min. Negotiated Rate	$254.04
Max. Negotiated Rate	$4,472.50
Rate for Payer: Aetna Commercial	$3,399.10
Rate for Payer: Aetna Medicare Advantage	$2,683.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,280.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,280.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,789.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,280.97
Rate for Payer: Cigna Commercial	$4,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,164.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,341.75
Rate for Payer: UnitedHealthcare Community & State	$282.66
Rate for Payer: Wellpoint Medicaid Managed Care	$254.04

MODULAR HEAD CONSTRAIN 36/-6mm

Facility

$8,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270665221
Hospital Revenue Code	278
Min. Negotiated Rate	$1,341.75
Max. Negotiated Rate	$2,164.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,789.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,164.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,341.75

MODULAR POST 25MM

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270699160
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

MODULAR POST 25MM

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270699160
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

MODULAR STEM LARGE

Facility

$9,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678493
Hospital Revenue Code	278
Min. Negotiated Rate	$262.70
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$292.30
Rate for Payer: Wellpoint Medicaid Managed Care	$262.70

MODULAR STEM LARGE

Facility

$9,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678493
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

MODULAR STEM SMALL

Facility

$27,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675298
Hospital Revenue Code	278
Min. Negotiated Rate	$773.90
Max. Negotiated Rate	$13,625.00
Rate for Payer: Aetna Commercial	$10,355.00
Rate for Payer: Aetna Medicare Advantage	$8,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,948.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,948.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,948.75
Rate for Payer: Cigna Commercial	$13,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,594.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,087.50
Rate for Payer: UnitedHealthcare Community & State	$861.10
Rate for Payer: Wellpoint Medicaid Managed Care	$773.90

MODULAR STEM SMALL

Facility

$27,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675298
Hospital Revenue Code	278
Min. Negotiated Rate	$4,087.50
Max. Negotiated Rate	$6,594.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,594.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,087.50

MODULAR TOWER TULIP 39MT0401

Facility

$6,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270698634
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

MODULAR TOWER TULIP 39MT0401

Facility

$6,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270698634
Hospital Revenue Code	278
Min. Negotiated Rate	$174.38
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$2,333.20
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00
Rate for Payer: UnitedHealthcare Community & State	$194.02
Rate for Payer: Wellpoint Medicaid Managed Care	$174.38

MODULE NVM5 NEXT GEN EMG

Facility

$5,500.00

Hospital Charge Code	270691454
Hospital Revenue Code	270
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,430.00
Rate for Payer: Oxford Commercial	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Commercial	$1,100.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

MODULE NVM5 NEXT GEN EMG

Facility

$5,500.00

Hospital Charge Code	270691454
Hospital Revenue Code	270
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

MODULUS TLIF-O 10X10X25MM 4D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698827
Hospital Revenue Code	278
Min. Negotiated Rate	$923.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$12,350.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00
Rate for Payer: UnitedHealthcare Community & State	$1,027.00
Rate for Payer: Wellpoint Medicaid Managed Care	$923.00

MODULUS TLIF-O 10X10X25MM 4D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698827
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 10X10X25MM 8D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697648
Hospital Revenue Code	278
Min. Negotiated Rate	$923.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$12,350.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00
Rate for Payer: UnitedHealthcare Community & State	$1,027.00
Rate for Payer: Wellpoint Medicaid Managed Care	$923.00

MODULUS TLIF-O 10X10X25MM 8D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697648
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 12X10X30MM 8D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697646
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 12X10X30MM 8D

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697646
Hospital Revenue Code	278
Min. Negotiated Rate	$923.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$12,350.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00
Rate for Payer: UnitedHealthcare Community & State	$1,027.00
Rate for Payer: Wellpoint Medicaid Managed Care	$923.00

Know your out-of-pocket cost for care.

All Charges