Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SHELL ACETABULAR OSSETIA TI 4

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270690530
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 OSSETIA TI 4

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270690530
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 SECTOR 64MM

Facility

$7,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270700355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,063.12
Max. Negotiated Rate	$1,715.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,715.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.12

SHELL ACETABULAR SECTOR 64MM

Facility

$7,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270700355
Hospital Revenue Code	278
Min. Negotiated Rate	$201.28
Max. Negotiated Rate	$3,543.75
Rate for Payer: Aetna Commercial	$2,693.25
Rate for Payer: Aetna Medicare Advantage	$2,126.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,807.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,807.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,807.31
Rate for Payer: Cigna Commercial	$3,543.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,715.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.12
Rate for Payer: UnitedHealthcare Community & State	$223.97
Rate for Payer: Wellpoint Medicaid Managed Care	$201.28

SHELL ACETABULAR SZ 22 52mm

Facility

$4,500.00

Hospital Charge Code	270664060
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 SZ 22 52mm

Facility

$4,500.00

Hospital Charge Code	270664060
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 ACETABULATE HOLE 54x23mm

Facility

$11,790.00

Service Code	HCPCS C1776
Hospital Charge Code	270679674
Hospital Revenue Code	278
Min. Negotiated Rate	$1,768.50
Max. Negotiated Rate	$2,853.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,358.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,853.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,768.50

SHELL ACETABULATE HOLE 54x23mm

Facility

$11,790.00

Service Code	HCPCS C1776
Hospital Charge Code	270679674
Hospital Revenue Code	278
Min. Negotiated Rate	$334.84
Max. Negotiated Rate	$5,895.00
Rate for Payer: Aetna Commercial	$4,480.20
Rate for Payer: Aetna Medicare Advantage	$3,537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,006.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,006.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,358.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,006.45
Rate for Payer: Cigna Commercial	$5,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,853.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,768.50
Rate for Payer: UnitedHealthcare Community & State	$372.56
Rate for Payer: Wellpoint Medicaid Managed Care	$334.84

SHELL ACET LTD G7 PPS 60 G

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690625
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

SHELL ACET LTD G7 PPS 60 G

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690625
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

SHELL ACET LTD PPS G7 50 MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689753
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

SHELL ACET LTD PPS G7 50 MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689753
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

SHELL ACET TI SOLID 54MM SZ E

Facility

$5,671.60

Service Code	HCPCS C1776
Hospital Charge Code	270692155
Hospital Revenue Code	278
Min. Negotiated Rate	$850.74
Max. Negotiated Rate	$1,372.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.53
Rate for Payer: Qualcare PPO/HMO/WC	$850.74

SHELL ACET TI SOLID 54MM SZ E

Facility

$5,671.60

Service Code	HCPCS C1776
Hospital Charge Code	270692155
Hospital Revenue Code	278
Min. Negotiated Rate	$161.07
Max. Negotiated Rate	$2,835.80
Rate for Payer: Aetna Commercial	$2,155.21
Rate for Payer: Aetna Medicare Advantage	$1,701.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,446.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,446.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,446.26
Rate for Payer: Cigna Commercial	$2,835.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.53
Rate for Payer: Qualcare PPO/HMO/WC	$850.74
Rate for Payer: UnitedHealthcare Community & State	$179.22
Rate for Payer: Wellpoint Medicaid Managed Care	$161.07

SHELL ACET TRITAN 50MM

Facility

$5,888.95

Service Code	HCPCS C1776
Hospital Charge Code	270697069
Hospital Revenue Code	278
Min. Negotiated Rate	$883.34
Max. Negotiated Rate	$1,425.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.13
Rate for Payer: Qualcare PPO/HMO/WC	$883.34

SHELL ACET TRITAN 50MM

Facility

$5,888.95

Service Code	HCPCS C1776
Hospital Charge Code	270697069
Hospital Revenue Code	278
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$2,944.47
Rate for Payer: Aetna Commercial	$2,237.80
Rate for Payer: Aetna Medicare Advantage	$1,766.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.68
Rate for Payer: Cigna Commercial	$2,944.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.13
Rate for Payer: Qualcare PPO/HMO/WC	$883.34
Rate for Payer: UnitedHealthcare Community & State	$186.09
Rate for Payer: Wellpoint Medicaid Managed Care	$167.25

SHELL CEMENTLESS SZ G

Facility

$9,500.00

Hospital Charge Code	270703303
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

SHELL CEMENTLESS SZ G

Facility

$9,500.00

Hospital Charge Code	270703303
Hospital Revenue Code	278
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

SHELL CLUSTER-HOLE 52MM

Facility

$10,850.00

Hospital Charge Code	270676367
Hospital Revenue Code	278
Min. Negotiated Rate	$308.14
Max. Negotiated Rate	$5,425.00
Rate for Payer: Aetna Commercial	$4,123.00
Rate for Payer: Aetna Medicare Advantage	$3,255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,766.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,766.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,766.75
Rate for Payer: Cigna Commercial	$5,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,625.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.50
Rate for Payer: UnitedHealthcare Community & State	$342.86
Rate for Payer: Wellpoint Medicaid Managed Care	$308.14

SHELL CLUSTER-HOLE 52MM

Facility

$10,850.00

Hospital Charge Code	270676367
Hospital Revenue Code	278
Min. Negotiated Rate	$1,627.50
Max. Negotiated Rate	$2,625.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,625.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.50

SHELL CLUST TRID PSL HA 50MM E

Facility

$4,734.75

Service Code	HCPCS C1776
Hospital Charge Code	270695125
Hospital Revenue Code	278
Min. Negotiated Rate	$710.21
Max. Negotiated Rate	$1,145.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.81
Rate for Payer: Qualcare PPO/HMO/WC	$710.21

SHELL CLUST TRID PSL HA 50MM E

Facility

$4,734.75

Service Code	HCPCS C1776
Hospital Charge Code	270695125
Hospital Revenue Code	278
Min. Negotiated Rate	$134.47
Max. Negotiated Rate	$2,367.38
Rate for Payer: Aetna Commercial	$1,799.20
Rate for Payer: Aetna Medicare Advantage	$1,420.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,207.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,207.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,207.36
Rate for Payer: Cigna Commercial	$2,367.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.81
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 FINNED G7 4 HOLE 58G

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270683725
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.50
Max. Negotiated Rate	$8,762.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50

SHELL FINNED G7 4 HOLE 58G

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270683725
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.36
Max. Negotiated Rate	$18,105.00
Rate for Payer: Aetna Commercial	$13,759.80
Rate for Payer: Aetna Medicare Advantage	$10,863.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,233.55
Rate for Payer: Cigna Commercial	$18,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50
Rate for Payer: UnitedHealthcare Community & State	$1,144.24
Rate for Payer: Wellpoint Medicaid Managed Care	$1,028.36

SHELL FLAREHAWK 29MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270695593
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

Know your out-of-pocket cost for care.

All Charges