Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OSMOLALITY,SERUM

Facility

$94.00

Service Code	HCPCS 83930
Hospital Charge Code	38477020
Hospital Revenue Code	301
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$17.98
Rate for Payer: Aetna Medicare Advantage	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.98
Rate for Payer: Cigna Commercial	$47.00
Rate for Payer: Cigna Medicare Advantage	$6.61
Rate for Payer: Clover Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$6.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.44
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.61
Rate for Payer: Wellcare Medicare Advantage	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$2.67

OSMOLALITY,SERUM

Facility

$94.00

Service Code	HCPCS 83930
Hospital Charge Code	38477020
Hospital Revenue Code	301
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$14.10
Rate for Payer: Qualcare PPO/HMO/WC	$14.10

OSMOLALITY (STOOL)

Facility

$390.00

Service Code	HCPCS 84999
Hospital Charge Code	3009883
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

OSMOLALITY (STOOL)

Facility

$390.00

Service Code	HCPCS 84999
Hospital Charge Code	3009883
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OSMOLALITY, URINE

Facility

$156.20

Service Code	HCPCS 83935
Hospital Charge Code	3004918
Hospital Revenue Code	301
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$18.55
Rate for Payer: Aetna Medicare Advantage	$22.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.74
Rate for Payer: Cigna Commercial	$78.10
Rate for Payer: Cigna Medicare Advantage	$6.82
Rate for Payer: Clover Medicare Advantage	$6.48
Rate for Payer: EmblemHealth Commercial	$20.46
Rate for Payer: Humana Medicare Advantage	$7.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.61
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.43
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.82
Rate for Payer: Wellcare Medicare Advantage	$6.82
Rate for Payer: Wellpoint Medicaid Managed Care	$4.44

OSMOLALITY, URINE

Facility

$156.20

Service Code	HCPCS 83935
Hospital Charge Code	3004918
Hospital Revenue Code	301
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$23.43
Rate for Payer: Qualcare PPO/HMO/WC	$23.43

OSMOLALITY,URINE

Facility

$102.00

Service Code	HCPCS 83935
Hospital Charge Code	38477023
Hospital Revenue Code	301
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$18.55
Rate for Payer: Aetna Medicare Advantage	$22.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.74
Rate for Payer: Cigna Commercial	$51.00
Rate for Payer: Cigna Medicare Advantage	$6.82
Rate for Payer: Clover Medicare Advantage	$6.48
Rate for Payer: EmblemHealth Commercial	$20.46
Rate for Payer: Humana Medicare Advantage	$7.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.82
Rate for Payer: Wellcare Medicare Advantage	$6.82
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

OSMOLALITY,URINE

Facility

$102.00

Service Code	HCPCS 83935
Hospital Charge Code	38477023
Hospital Revenue Code	301
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$15.30
Rate for Payer: Qualcare PPO/HMO/WC	$15.30

OSS 1.5CC

Facility

$4,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270703615
Hospital Revenue Code	278
Min. Negotiated Rate	$124.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$138.25
Rate for Payer: Wellpoint Medicaid Managed Care	$124.25

OSS 1.5CC

Facility

$4,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270703615
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

OSS 3CM RESURFACING KIT

Facility

$65,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270681527
Hospital Revenue Code	278
Min. Negotiated Rate	$9,832.50
Max. Negotiated Rate	$15,863.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,863.10
Rate for Payer: Qualcare PPO/HMO/WC	$9,832.50

OSS 3CM RESURFACING KIT

Facility

$65,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270681527
Hospital Revenue Code	278
Min. Negotiated Rate	$1,861.62
Max. Negotiated Rate	$32,775.00
Rate for Payer: Aetna Commercial	$24,909.00
Rate for Payer: Aetna Medicare Advantage	$19,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,715.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,715.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,715.25
Rate for Payer: Cigna Commercial	$32,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,863.10
Rate for Payer: Qualcare PPO/HMO/WC	$9,832.50
Rate for Payer: UnitedHealthcare Community & State	$2,071.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1,861.62

OSS 4CM BONE PIN

Facility

$48,690.00

Service Code	HCPCS C1713
Hospital Charge Code	270691630
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.80
Max. Negotiated Rate	$24,345.00
Rate for Payer: Aetna Commercial	$18,502.20
Rate for Payer: Aetna Medicare Advantage	$14,607.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,415.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,415.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,738.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,415.95
Rate for Payer: Cigna Commercial	$24,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,782.98
Rate for Payer: Qualcare PPO/HMO/WC	$7,303.50
Rate for Payer: UnitedHealthcare Community & State	$1,538.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1,382.80

OSS 4CM BONE PIN

Facility

$48,690.00

Service Code	HCPCS C1713
Hospital Charge Code	270691630
Hospital Revenue Code	278
Min. Negotiated Rate	$7,303.50
Max. Negotiated Rate	$11,782.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,738.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,782.98
Rate for Payer: Qualcare PPO/HMO/WC	$7,303.50

OSS ADAPT FEM DIAPHYSEAL SEG

Facility

$1,915.65

Service Code	HCPCS C1776
Hospital Charge Code	270697109
Hospital Revenue Code	278
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$957.83
Rate for Payer: Aetna Commercial	$727.95
Rate for Payer: Aetna Medicare Advantage	$574.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$488.49
Rate for Payer: Cigna Commercial	$957.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.59
Rate for Payer: Qualcare PPO/HMO/WC	$287.35
Rate for Payer: UnitedHealthcare Community & State	$60.53
Rate for Payer: Wellpoint Medicaid Managed Care	$54.40

OSS ADAPT FEM DIAPHYSEAL SEG

Facility

$1,915.65

Service Code	HCPCS C1776
Hospital Charge Code	270697109
Hospital Revenue Code	278
Min. Negotiated Rate	$287.35
Max. Negotiated Rate	$463.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.59
Rate for Payer: Qualcare PPO/HMO/WC	$287.35

OSS AVL TI 63MM MOD BSPLT

Facility

$28,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684635
Hospital Revenue Code	278
Min. Negotiated Rate	$4,275.00
Max. Negotiated Rate	$6,897.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,897.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,275.00

OSS AVL TI 63MM MOD BSPLT

Facility

$28,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684635
Hospital Revenue Code	278
Min. Negotiated Rate	$809.40
Max. Negotiated Rate	$14,250.00
Rate for Payer: Aetna Commercial	$10,830.00
Rate for Payer: Aetna Medicare Advantage	$8,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,267.50
Rate for Payer: Cigna Commercial	$14,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,897.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,275.00
Rate for Payer: UnitedHealthcare Community & State	$900.60
Rate for Payer: Wellpoint Medicaid Managed Care	$809.40

OSS AVL TIB BUSHING SET

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684637
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

OSS AVL TIB BUSHING SET

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684637
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

OSS AVL TIBIAL BEARING

Facility

$6,270.00

Service Code	HCPCS C1776
Hospital Charge Code	270684690
Hospital Revenue Code	278
Min. Negotiated Rate	$940.50
Max. Negotiated Rate	$1,517.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,517.34
Rate for Payer: Qualcare PPO/HMO/WC	$940.50

OSS AVL TIBIAL BEARING

Facility

$6,270.00

Service Code	HCPCS C1776
Hospital Charge Code	270684690
Hospital Revenue Code	278
Min. Negotiated Rate	$178.07
Max. Negotiated Rate	$3,135.00
Rate for Payer: Aetna Commercial	$2,382.60
Rate for Payer: Aetna Medicare Advantage	$1,881.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,598.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,598.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,254.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,598.85
Rate for Payer: Cigna Commercial	$3,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,517.34
Rate for Payer: Qualcare PPO/HMO/WC	$940.50
Rate for Payer: UnitedHealthcare Community & State	$198.13
Rate for Payer: Wellpoint Medicaid Managed Care	$178.07

OSS AVL TI LOCK RING SET

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270684640
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OSS AVL TI LOCK RING SET

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270684640
Hospital Revenue Code	278
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$68.16

OSS AVL TI YOKE SET 12 14 16MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684638
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

Know your out-of-pocket cost for care.

All Charges