Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PATCH VASCULAR 0.6MM 5x7.5CM

Facility

$1,580.00

Service Code	HCPCS C1768
Hospital Charge Code	270655457
Hospital Revenue Code	278
Min. Negotiated Rate	$237.00
Max. Negotiated Rate	$382.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$316.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.36
Rate for Payer: Qualcare PPO/HMO/WC	$237.00

PATCH VASCULAR 0.6MM 5x7.5CM

Facility

$1,580.00

Service Code	HCPCS C1768
Hospital Charge Code	270655457
Hospital Revenue Code	278
Min. Negotiated Rate	$44.87
Max. Negotiated Rate	$790.00
Rate for Payer: Aetna Commercial	$600.40
Rate for Payer: Aetna Medicare Advantage	$474.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$402.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$402.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$316.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$402.90
Rate for Payer: Cigna Commercial	$790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.36
Rate for Payer: Qualcare PPO/HMO/WC	$237.00
Rate for Payer: UnitedHealthcare Community & State	$49.93
Rate for Payer: Wellpoint Medicaid Managed Care	$44.87

PATCH VENTRALEX W/STRAP LG

Facility

$3,455.00

Hospital Charge Code	270642380
Hospital Revenue Code	278
Min. Negotiated Rate	$518.25
Max. Negotiated Rate	$836.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$691.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$836.11
Rate for Payer: Qualcare PPO/HMO/WC	$518.25

PATCH VENTRALEX W/STRAP LG

Facility

$3,455.00

Hospital Charge Code	270642380
Hospital Revenue Code	278
Min. Negotiated Rate	$98.12
Max. Negotiated Rate	$1,727.50
Rate for Payer: Aetna Commercial	$1,312.90
Rate for Payer: Aetna Medicare Advantage	$1,036.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$881.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$881.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$691.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$881.02
Rate for Payer: Cigna Commercial	$1,727.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$836.11
Rate for Payer: Qualcare PPO/HMO/WC	$518.25
Rate for Payer: UnitedHealthcare Community & State	$109.18
Rate for Payer: Wellpoint Medicaid Managed Care	$98.12

PATCH VENTRALEX W/STRAP MED

Facility

$2,845.00

Service Code	HCPCS C1781
Hospital Charge Code	270632015
Hospital Revenue Code	278
Min. Negotiated Rate	$426.75
Max. Negotiated Rate	$688.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.49
Rate for Payer: Qualcare PPO/HMO/WC	$426.75

PATCH VENTRALEX W/STRAP MED

Facility

$2,845.00

Service Code	HCPCS C1781
Hospital Charge Code	270632015
Hospital Revenue Code	278
Min. Negotiated Rate	$80.80
Max. Negotiated Rate	$1,422.50
Rate for Payer: Aetna Commercial	$1,081.10
Rate for Payer: Aetna Medicare Advantage	$853.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.48
Rate for Payer: Cigna Commercial	$1,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.49
Rate for Payer: Qualcare PPO/HMO/WC	$426.75
Rate for Payer: UnitedHealthcare Community & State	$89.90
Rate for Payer: Wellpoint Medicaid Managed Care	$80.80

PATCH VENTRALEX W/STRAP SML

Facility

$2,822.00

Hospital Charge Code	270632014
Hospital Revenue Code	278
Min. Negotiated Rate	$423.30
Max. Negotiated Rate	$682.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$564.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.92
Rate for Payer: Qualcare PPO/HMO/WC	$423.30

PATCH VENTRALEX W/STRAP SML

Facility

$2,822.00

Hospital Charge Code	270632014
Hospital Revenue Code	278
Min. Negotiated Rate	$80.14
Max. Negotiated Rate	$1,411.00
Rate for Payer: Aetna Commercial	$1,072.36
Rate for Payer: Aetna Medicare Advantage	$846.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$719.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$719.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$564.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$719.61
Rate for Payer: Cigna Commercial	$1,411.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.92
Rate for Payer: Qualcare PPO/HMO/WC	$423.30
Rate for Payer: UnitedHealthcare Community & State	$89.18
Rate for Payer: Wellpoint Medicaid Managed Care	$80.14

PATE 44MM

Facility

$3,075.00

Hospital Charge Code	270703197
Hospital Revenue Code	278
Min. Negotiated Rate	$87.33
Max. Negotiated Rate	$1,537.50
Rate for Payer: Aetna Commercial	$1,168.50
Rate for Payer: Aetna Medicare Advantage	$922.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$784.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$784.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$784.12
Rate for Payer: Cigna Commercial	$1,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.15
Rate for Payer: Qualcare PPO/HMO/WC	$461.25
Rate for Payer: UnitedHealthcare Community & State	$97.17
Rate for Payer: Wellpoint Medicaid Managed Care	$87.33

PATE 44MM

Facility

$3,075.00

Hospital Charge Code	270703197
Hospital Revenue Code	278
Min. Negotiated Rate	$461.25
Max. Negotiated Rate	$744.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.15
Rate for Payer: Qualcare PPO/HMO/WC	$461.25

PATELLA 1 29MM 9MM

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270691041
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

PATELLA 1 29MM 9MM

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270691041
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

PATELLA 32 MM

Facility

$1,500.00

Hospital Charge Code	270676719
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

PATELLA 32 MM

Facility

$1,500.00

Hospital Charge Code	270676719
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 35MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676628
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

PATELLA 35MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676628
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 35MM ALL POLY NEXGE

Facility

$2,297.50

Hospital Charge Code	270661348
Hospital Revenue Code	278
Min. Negotiated Rate	$344.62
Max. Negotiated Rate	$556.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.00
Rate for Payer: Qualcare PPO/HMO/WC	$344.62

PATELLA 35MM ALL POLY NEXGE

Facility

$2,297.50

Hospital Charge Code	270661348
Hospital Revenue Code	278
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$1,148.75
Rate for Payer: Aetna Commercial	$873.05
Rate for Payer: Aetna Medicare Advantage	$689.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$585.86
Rate for Payer: Cigna Commercial	$1,148.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.00
Rate for Payer: Qualcare PPO/HMO/WC	$344.62
Rate for Payer: UnitedHealthcare Community & State	$72.60
Rate for Payer: Wellpoint Medicaid Managed Care	$65.25

PATELLA 3PEG CEMENTED 26MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681295
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

PATELLA 3PEG CEMENTED 26MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681295
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3PEG CEMENTED 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675760
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

PATELLA 3PEG CEMENTED 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675760
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3 PEG STD 28x8.0MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639116
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3 PEG STD 28x8.0MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639116
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

PATELLA 41MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676728
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Know your out-of-pocket cost for care.

All Charges