Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SHELL HEMI SOLID BACK 52MM

Facility

$12,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270679082
Hospital Revenue Code	278
Min. Negotiated Rate	$353.44
Max. Negotiated Rate	$6,222.50
Rate for Payer: Aetna Commercial	$4,729.10
Rate for Payer: Aetna Medicare Advantage	$3,733.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,173.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,173.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,173.47
Rate for Payer: Cigna Commercial	$6,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,011.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.75
Rate for Payer: UnitedHealthcare Community & State	$393.26
Rate for Payer: Wellpoint Medicaid Managed Care	$353.44

SHELL HEMI SOLID BACK 52MM

Facility

$12,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270679082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,866.75
Max. Negotiated Rate	$3,011.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,011.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.75

SHELL HEMI SOLID BACK 54MM

Facility

$12,447.50

Service Code	HCPCS C1776
Hospital Charge Code	270678862
Hospital Revenue Code	278
Min. Negotiated Rate	$1,867.12
Max. Negotiated Rate	$3,012.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.12

SHELL HEMI SOLID BACK 54MM

Facility

$12,447.50

Service Code	HCPCS C1776
Hospital Charge Code	270678862
Hospital Revenue Code	278
Min. Negotiated Rate	$353.51
Max. Negotiated Rate	$6,223.75
Rate for Payer: Aetna Commercial	$4,730.05
Rate for Payer: Aetna Medicare Advantage	$3,734.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,174.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,174.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,174.11
Rate for Payer: Cigna Commercial	$6,223.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.12
Rate for Payer: UnitedHealthcare Community & State	$393.34
Rate for Payer: Wellpoint Medicaid Managed Care	$353.51

SHELL HEMI SOLID BACK 58MM

Facility

$5,754.90

Hospital Charge Code	270677483
Hospital Revenue Code	278
Min. Negotiated Rate	$163.44
Max. Negotiated Rate	$2,877.45
Rate for Payer: Aetna Commercial	$2,186.86
Rate for Payer: Aetna Medicare Advantage	$1,726.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,467.50
Rate for Payer: Cigna Commercial	$2,877.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,392.69
Rate for Payer: Qualcare PPO/HMO/WC	$863.24
Rate for Payer: UnitedHealthcare Community & State	$181.85
Rate for Payer: Wellpoint Medicaid Managed Care	$163.44

SHELL HEMI SOLID BACK 58MM

Facility

$5,754.90

Hospital Charge Code	270677483
Hospital Revenue Code	278
Min. Negotiated Rate	$863.24
Max. Negotiated Rate	$1,392.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,392.69
Rate for Payer: Qualcare PPO/HMO/WC	$863.24

SHELL LORDOT H11 FLHWK 25MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696183
Hospital Revenue Code	278
Min. Negotiated Rate	$560.90
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$7,505.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50
Rate for Payer: UnitedHealthcare Community & State	$624.10
Rate for Payer: Wellpoint Medicaid Managed Care	$560.90

SHELL LORDOT H11 FLHWK 25MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696183
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

SHELL LORDOTIC 29 MM TI 9 DEG

Facility

$18,975.00

Service Code	HCPCS L8699
Hospital Charge Code	270692917
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

SHELL LORDOTIC 29 MM TI 9 DEG

Facility

$18,975.00

Service Code	HCPCS L8699
Hospital Charge Code	270692917
Hospital Revenue Code	278
Min. Negotiated Rate	$538.89
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$599.61
Rate for Payer: Wellpoint Medicaid Managed Care	$538.89

SHELL MPACT DM ACETABULAR 056

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694236
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 MPACT DM ACETABULAR 056

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694236
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 OSSEOTI MUTLI HOLE 60

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270686593
Hospital Revenue Code	278
Min. Negotiated Rate	$2,848.50
Max. Negotiated Rate	$4,595.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50

SHELL OSSEOTI MUTLI HOLE 60

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270686593
Hospital Revenue Code	278
Min. Negotiated Rate	$539.32
Max. Negotiated Rate	$9,495.00
Rate for Payer: Aetna Commercial	$7,216.20
Rate for Payer: Aetna Medicare Advantage	$5,697.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,842.45
Rate for Payer: Cigna Commercial	$9,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50
Rate for Payer: UnitedHealthcare Community & State	$600.08
Rate for Payer: Wellpoint Medicaid Managed Care	$539.32

SHELL OSSEOT MULT HOLE 48MMSZC

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270695251
Hospital Revenue Code	278
Min. Negotiated Rate	$539.32
Max. Negotiated Rate	$9,495.00
Rate for Payer: Aetna Commercial	$7,216.20
Rate for Payer: Aetna Medicare Advantage	$5,697.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,842.45
Rate for Payer: Cigna Commercial	$9,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50
Rate for Payer: UnitedHealthcare Community & State	$600.08
Rate for Payer: Wellpoint Medicaid Managed Care	$539.32

SHELL OSSEOT MULT HOLE 48MMSZC

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270695251
Hospital Revenue Code	278
Min. Negotiated Rate	$2,848.50
Max. Negotiated Rate	$4,595.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50

SHELL PPS LTD ACET 52 E

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690468
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 PPS LTD ACET 52 E

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690468
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

SHELLQUADPRIMEBFPROCOTYL50MM

Facility

$14,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270697653
Hospital Revenue Code	278
Min. Negotiated Rate	$408.96
Max. Negotiated Rate	$7,200.00
Rate for Payer: Aetna Commercial	$5,472.00
Rate for Payer: Aetna Medicare Advantage	$4,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,672.00
Rate for Payer: Cigna Commercial	$7,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00
Rate for Payer: UnitedHealthcare Community & State	$455.04
Rate for Payer: Wellpoint Medicaid Managed Care	$408.96

SHELLQUADPRIMEBFPROCOTYL50MM

Facility

$14,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270697653
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.00
Max. Negotiated Rate	$3,484.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00

SHELL RINGLOC ACETABULAR 60 MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675682
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 RINGLOC ACETABULAR 60 MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675682
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 SHORT 29MM

Facility

$10,000.00

Hospital Charge Code	270702407
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 SHORT 29MM

Facility

$10,000.00

Hospital Charge Code	270702407
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 SHORT 30MM FLAREHAWK

Facility

$18,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270692112
Hospital Revenue Code	278
Min. Negotiated Rate	$518.30
Max. Negotiated Rate	$9,125.00
Rate for Payer: Aetna Commercial	$6,935.00
Rate for Payer: Aetna Medicare Advantage	$5,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,653.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,653.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,653.75
Rate for Payer: Cigna Commercial	$9,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,416.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,737.50
Rate for Payer: UnitedHealthcare Community & State	$576.70
Rate for Payer: Wellpoint Medicaid Managed Care	$518.30

Know your out-of-pocket cost for care.

All Charges