Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PSN REV FEM DIST AUG SZ5 5MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270695260
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

PSN REV FEM DIST AUG SZ7 5MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694630
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

PSN REV FEM DIST AUG SZ7 5MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694630
Hospital Revenue Code	278
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

PSN REV FEM DIST AUG SZ 9 15MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270697459
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.31
Max. Negotiated Rate	$1,991.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31

PSN REV FEM DIST AUG SZ 9 15MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270697459
Hospital Revenue Code	278
Min. Negotiated Rate	$233.70
Max. Negotiated Rate	$4,114.38
Rate for Payer: Aetna Commercial	$3,126.93
Rate for Payer: Aetna Medicare Advantage	$2,468.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,098.33
Rate for Payer: Cigna Commercial	$4,114.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31
Rate for Payer: UnitedHealthcare Community & State	$260.03
Rate for Payer: Wellpoint Medicaid Managed Care	$233.70

PSN REV FEM POST AUG SZ 55MM

Facility

$6,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270692738
Hospital Revenue Code	278
Min. Negotiated Rate	$193.40
Max. Negotiated Rate	$3,405.00
Rate for Payer: Aetna Commercial	$2,587.80
Rate for Payer: Aetna Medicare Advantage	$2,043.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,736.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,736.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,736.55
Rate for Payer: Cigna Commercial	$3,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,648.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.50
Rate for Payer: UnitedHealthcare Community & State	$215.20
Rate for Payer: Wellpoint Medicaid Managed Care	$193.40

PSN REV FEM POST AUG SZ 55MM

Facility

$6,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270692738
Hospital Revenue Code	278
Min. Negotiated Rate	$1,021.50
Max. Negotiated Rate	$1,648.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,648.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.50

PSN REV FEM POST AUG SZ7 5MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694631
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

PSN REV FEM POST AUG SZ7 5MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694631
Hospital Revenue Code	278
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

PSNREVSTRSPLINESTEMEXT17X135MM

Facility

$12,506.25

Service Code	HCPCS C1776
Hospital Charge Code	270695147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.94
Max. Negotiated Rate	$3,026.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,026.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.94

PSNREVSTRSPLINESTEMEXT17X135MM

Facility

$12,506.25

Service Code	HCPCS C1776
Hospital Charge Code	270695147
Hospital Revenue Code	278
Min. Negotiated Rate	$355.18
Max. Negotiated Rate	$6,253.12
Rate for Payer: Aetna Commercial	$4,752.38
Rate for Payer: Aetna Medicare Advantage	$3,751.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,189.09
Rate for Payer: Cigna Commercial	$6,253.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,026.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.94
Rate for Payer: UnitedHealthcare Community & State	$395.20
Rate for Payer: Wellpoint Medicaid Managed Care	$355.18

PSNREVSTSPLINESTEMEXT16X135MM

Facility

$12,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270697605
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

PSNREVSTSPLINESTEMEXT16X135MM

Facility

$12,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270697605
Hospital Revenue Code	278
Min. Negotiated Rate	$366.50
Max. Negotiated Rate	$6,452.50
Rate for Payer: Aetna Commercial	$4,903.90
Rate for Payer: Aetna Medicare Advantage	$3,871.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,290.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,290.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,290.78
Rate for Payer: Cigna Commercial	$6,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,123.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.75
Rate for Payer: UnitedHealthcare Community & State	$407.80
Rate for Payer: Wellpoint Medicaid Managed Care	$366.50

PSN REV ST SP STEM XT 14X135MM

Facility

$12,506.25

Service Code	HCPCS C1776
Hospital Charge Code	270694634
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.94
Max. Negotiated Rate	$3,026.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,026.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.94

PSN REV ST SP STEM XT 14X135MM

Facility

$12,506.25

Service Code	HCPCS C1776
Hospital Charge Code	270694634
Hospital Revenue Code	278
Min. Negotiated Rate	$355.18
Max. Negotiated Rate	$6,253.12
Rate for Payer: Aetna Commercial	$4,752.38
Rate for Payer: Aetna Medicare Advantage	$3,751.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,189.09
Rate for Payer: Cigna Commercial	$6,253.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,026.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.94
Rate for Payer: UnitedHealthcare Community & State	$395.20
Rate for Payer: Wellpoint Medicaid Managed Care	$355.18

PSN REV ST SP STEM XT 15X135MM

Facility

$12,506.25

Service Code	HCPCS C1776
Hospital Charge Code	270694629
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.94
Max. Negotiated Rate	$3,026.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,026.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.94

PSN REV ST SP STEM XT 15X135MM

Facility

$12,506.25

Service Code	HCPCS C1776
Hospital Charge Code	270694629
Hospital Revenue Code	278
Min. Negotiated Rate	$355.18
Max. Negotiated Rate	$6,253.12
Rate for Payer: Aetna Commercial	$4,752.38
Rate for Payer: Aetna Medicare Advantage	$3,751.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,189.09
Rate for Payer: Cigna Commercial	$6,253.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,026.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.94
Rate for Payer: UnitedHealthcare Community & State	$395.20
Rate for Payer: Wellpoint Medicaid Managed Care	$355.18

PSN REV TIB FIXED CMT SZ E

Facility

$18,486.25

Service Code	HCPCS C1776
Hospital Charge Code	270694636
Hospital Revenue Code	278
Min. Negotiated Rate	$525.01
Max. Negotiated Rate	$9,243.12
Rate for Payer: Aetna Commercial	$7,024.77
Rate for Payer: Aetna Medicare Advantage	$5,545.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,713.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,713.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,713.99
Rate for Payer: Cigna Commercial	$9,243.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,772.94
Rate for Payer: UnitedHealthcare Community & State	$584.17
Rate for Payer: Wellpoint Medicaid Managed Care	$525.01

PSN REV TIB FIXED CMT SZ E

Facility

$18,486.25

Service Code	HCPCS C1776
Hospital Charge Code	270694636
Hospital Revenue Code	278
Min. Negotiated Rate	$2,772.94
Max. Negotiated Rate	$4,473.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,772.94

PSN REV TIB FIXED KEEL CMT

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690590
Hospital Revenue Code	278
Min. Negotiated Rate	$525.04
Max. Negotiated Rate	$9,243.75
Rate for Payer: Aetna Commercial	$7,025.25
Rate for Payer: Aetna Medicare Advantage	$5,546.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,714.31
Rate for Payer: Cigna Commercial	$9,243.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12
Rate for Payer: UnitedHealthcare Community & State	$584.21
Rate for Payer: Wellpoint Medicaid Managed Care	$525.04

PSN REV TIB FIXED KEEL CMT

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690590
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$4,473.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12

PSN REV TIB FIX KEEL CMT SZG L

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270695145
Hospital Revenue Code	278
Min. Negotiated Rate	$525.04
Max. Negotiated Rate	$9,243.75
Rate for Payer: Aetna Commercial	$7,025.25
Rate for Payer: Aetna Medicare Advantage	$5,546.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,714.31
Rate for Payer: Cigna Commercial	$9,243.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12
Rate for Payer: UnitedHealthcare Community & State	$584.21
Rate for Payer: Wellpoint Medicaid Managed Care	$525.04

PSN REV TIB FIX KEEL CMT SZG L

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270695145
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$4,473.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12

PSNREVTIBFIXKEELCMT SZ G RT

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270697636
Hospital Revenue Code	278
Min. Negotiated Rate	$541.52
Max. Negotiated Rate	$9,533.75
Rate for Payer: Aetna Commercial	$7,245.65
Rate for Payer: Aetna Medicare Advantage	$5,720.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,862.21
Rate for Payer: Cigna Commercial	$9,533.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12
Rate for Payer: UnitedHealthcare Community & State	$602.53
Rate for Payer: Wellpoint Medicaid Managed Care	$541.52

PSNREVTIBFIXKEELCMT SZ G RT

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270697636
Hospital Revenue Code	278
Min. Negotiated Rate	$2,860.12
Max. Negotiated Rate	$4,614.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12

Know your out-of-pocket cost for care.

All Charges