Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SHELL ACETABULAR 50 MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688348
Hospital Revenue Code	278
Min. Negotiated Rate	$446.45
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$496.75
Rate for Payer: Wellpoint Medicaid Managed Care	$446.45

SHELL ACETABULAR 50MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	2706883482
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL ACETABULAR 50MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	2706883482
Hospital Revenue Code	278
Min. Negotiated Rate	$446.45
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$496.75
Rate for Payer: Wellpoint Medicaid Managed Care	$446.45

SHELL ACETABULAR 52mm MPACTDM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681003
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

SHELL ACETABULAR 52mm MPACTDM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681003
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETABULAR 54MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689571
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL ACETABULAR 54MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689571
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

SHELL ACETABULAR 54mm SIZE 24

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270665222
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

SHELL ACETABULAR 54mm SIZE 24

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270665222
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

SHELL ACETABULAR 56MM SZ F

Facility

$6,750.00

Hospital Charge Code	270677541
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL ACETABULAR 56MM SZ F

Facility

$6,750.00

Hospital Charge Code	270677541
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

SHELL ACETABULAR 58 MPACT

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694004
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

SHELL ACETABULAR 58 MPACT

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694004
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETABULAR 62mm SIZE 26

Facility

$8,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270645622
Hospital Revenue Code	278
Min. Negotiated Rate	$230.75
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$3,087.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75
Rate for Payer: UnitedHealthcare Community & State	$256.75
Rate for Payer: Wellpoint Medicaid Managed Care	$230.75

SHELL ACETABULAR 62mm SIZE 26

Facility

$8,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270645622
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

SHELL ACETABULAR 70mm MPACTH

Facility

$19,475.00

Service Code	HCPCS C1776
Hospital Charge Code	270684305
Hospital Revenue Code	278
Min. Negotiated Rate	$553.09
Max. Negotiated Rate	$9,737.50
Rate for Payer: Aetna Commercial	$7,400.50
Rate for Payer: Aetna Medicare Advantage	$5,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,966.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,966.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,966.12
Rate for Payer: Cigna Commercial	$9,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,921.25
Rate for Payer: UnitedHealthcare Community & State	$615.41
Rate for Payer: Wellpoint Medicaid Managed Care	$553.09

SHELL ACETABULAR 70mm MPACTH

Facility

$19,475.00

Service Code	HCPCS C1776
Hospital Charge Code	270684305
Hospital Revenue Code	278
Min. Negotiated Rate	$2,921.25
Max. Negotiated Rate	$4,712.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,921.25

SHELL ACETABULAR CLUSTER 44MM

Facility

$6,349.50

Hospital Charge Code	270676685
Hospital Revenue Code	278
Min. Negotiated Rate	$180.33
Max. Negotiated Rate	$3,174.75
Rate for Payer: Aetna Commercial	$2,412.81
Rate for Payer: Aetna Medicare Advantage	$1,904.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,619.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,619.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,619.12
Rate for Payer: Cigna Commercial	$3,174.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.58
Rate for Payer: Qualcare PPO/HMO/WC	$952.42
Rate for Payer: UnitedHealthcare Community & State	$200.64
Rate for Payer: Wellpoint Medicaid Managed Care	$180.33

SHELL ACETABULAR CLUSTER 44MM

Facility

$6,349.50

Hospital Charge Code	270676685
Hospital Revenue Code	278
Min. Negotiated Rate	$952.42
Max. Negotiated Rate	$1,536.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.58
Rate for Payer: Qualcare PPO/HMO/WC	$952.42

SHELL ACETABULAR CLUSTER 52MM

Facility

$9,047.50

Service Code	HCPCS C1776
Hospital Charge Code	270646336
Hospital Revenue Code	278
Min. Negotiated Rate	$256.95
Max. Negotiated Rate	$4,523.75
Rate for Payer: Aetna Commercial	$3,438.05
Rate for Payer: Aetna Medicare Advantage	$2,714.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,307.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,307.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,809.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,307.11
Rate for Payer: Cigna Commercial	$4,523.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,189.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,357.12
Rate for Payer: UnitedHealthcare Community & State	$285.90
Rate for Payer: Wellpoint Medicaid Managed Care	$256.95

SHELL ACETABULAR CLUSTER 52MM

Facility

$9,047.50

Service Code	HCPCS C1776
Hospital Charge Code	270646336
Hospital Revenue Code	278
Min. Negotiated Rate	$1,357.12
Max. Negotiated Rate	$2,189.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,809.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,189.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,357.12

SHELL ACETABULAR CLUSTER 54MM

Facility

$4,734.70

Service Code	HCPCS C1776
Hospital Charge Code	270692082
Hospital Revenue Code	278
Min. Negotiated Rate	$134.47
Max. Negotiated Rate	$2,367.35
Rate for Payer: Aetna Commercial	$1,799.19
Rate for Payer: Aetna Medicare Advantage	$1,420.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,207.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,207.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,207.35
Rate for Payer: Cigna Commercial	$2,367.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.80
Rate for Payer: Qualcare PPO/HMO/WC	$710.21
Rate for Payer: UnitedHealthcare Community & State	$149.62
Rate for Payer: Wellpoint Medicaid Managed Care	$134.47

SHELL ACETABULAR CLUSTER 54MM

Facility

$4,734.70

Service Code	HCPCS C1776
Hospital Charge Code	270692082
Hospital Revenue Code	278
Min. Negotiated Rate	$710.21
Max. Negotiated Rate	$1,145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.80
Rate for Payer: Qualcare PPO/HMO/WC	$710.21

SHELL ACETABULAR MULTI-HOLE 50

Facility

$14,140.00

Service Code	HCPCS C1776
Hospital Charge Code	270679047
Hospital Revenue Code	278
Min. Negotiated Rate	$2,121.00
Max. Negotiated Rate	$3,421.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,828.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,421.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,121.00

SHELL ACETABULAR MULTI-HOLE 50

Facility

$14,140.00

Service Code	HCPCS C1776
Hospital Charge Code	270679047
Hospital Revenue Code	278
Min. Negotiated Rate	$401.58
Max. Negotiated Rate	$7,070.00
Rate for Payer: Aetna Commercial	$5,373.20
Rate for Payer: Aetna Medicare Advantage	$4,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,828.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,605.70
Rate for Payer: Cigna Commercial	$7,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,421.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,121.00
Rate for Payer: UnitedHealthcare Community & State	$446.82
Rate for Payer: Wellpoint Medicaid Managed Care	$401.58

Know your out-of-pocket cost for care.

All Charges