Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SHELL SHORT 30MM FLAREHAWK

Facility

$18,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270692112
Hospital Revenue Code	278
Min. Negotiated Rate	$2,737.50
Max. Negotiated Rate	$4,416.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,416.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,737.50

SHELL TRIDENT II 3H SZ C 46MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691375
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SHELL TRIDENT II 3H SZ C 46MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691375
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

SHELL TRIDENT II CLUSTER 52mm

Facility

$6,055.50

Service Code	HCPCS C1776
Hospital Charge Code	270685519
Hospital Revenue Code	278
Min. Negotiated Rate	$171.98
Max. Negotiated Rate	$3,027.75
Rate for Payer: Aetna Commercial	$2,301.09
Rate for Payer: Aetna Medicare Advantage	$1,816.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,544.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,544.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,211.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,544.15
Rate for Payer: Cigna Commercial	$3,027.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,465.43
Rate for Payer: Qualcare PPO/HMO/WC	$908.33
Rate for Payer: UnitedHealthcare Community & State	$191.35
Rate for Payer: Wellpoint Medicaid Managed Care	$171.98

SHELL TRIDENT II CLUSTER 52mm

Facility

$6,055.50

Service Code	HCPCS C1776
Hospital Charge Code	270685519
Hospital Revenue Code	278
Min. Negotiated Rate	$908.33
Max. Negotiated Rate	$1,465.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,211.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,465.43
Rate for Payer: Qualcare PPO/HMO/WC	$908.33

SHELL TRIDENT II CLUSTER 52MM

Facility

$6,055.00

Service Code	HCPCS C1776
Hospital Charge Code	270686454
Hospital Revenue Code	278
Min. Negotiated Rate	$171.96
Max. Negotiated Rate	$3,027.50
Rate for Payer: Aetna Commercial	$2,300.90
Rate for Payer: Aetna Medicare Advantage	$1,816.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,544.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,544.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,211.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,544.03
Rate for Payer: Cigna Commercial	$3,027.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,465.31
Rate for Payer: Qualcare PPO/HMO/WC	$908.25
Rate for Payer: UnitedHealthcare Community & State	$191.34
Rate for Payer: Wellpoint Medicaid Managed Care	$171.96

SHELL TRIDENT II CLUSTER 52MM

Facility

$6,055.00

Service Code	HCPCS C1776
Hospital Charge Code	270686454
Hospital Revenue Code	278
Min. Negotiated Rate	$908.25
Max. Negotiated Rate	$1,465.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,211.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,465.31
Rate for Payer: Qualcare PPO/HMO/WC	$908.25

SHELL TRIDENTII TRITANIUM 54MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686547
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

SHELL TRIDENTII TRITANIUM 54MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686547
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SHELL TRIDENT II TRITA SOL 52E

Facility

$5,697.75

Service Code	HCPCS C1776
Hospital Charge Code	270693166
Hospital Revenue Code	278
Min. Negotiated Rate	$854.66
Max. Negotiated Rate	$1,378.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.86
Rate for Payer: Qualcare PPO/HMO/WC	$854.66

SHELL TRIDENT II TRITA SOL 52E

Facility

$5,697.75

Service Code	HCPCS C1776
Hospital Charge Code	270693166
Hospital Revenue Code	278
Min. Negotiated Rate	$161.82
Max. Negotiated Rate	$2,848.88
Rate for Payer: Aetna Commercial	$2,165.14
Rate for Payer: Aetna Medicare Advantage	$1,709.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.93
Rate for Payer: Cigna Commercial	$2,848.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.86
Rate for Payer: Qualcare PPO/HMO/WC	$854.66
Rate for Payer: UnitedHealthcare Community & State	$180.05
Rate for Payer: Wellpoint Medicaid Managed Care	$161.82

SHELL TRID TRITA CLUSHLE 60MM

Facility

$6,808.15

Service Code	HCPCS C1776
Hospital Charge Code	270659458
Hospital Revenue Code	278
Min. Negotiated Rate	$193.35
Max. Negotiated Rate	$3,404.07
Rate for Payer: Aetna Commercial	$2,587.10
Rate for Payer: Aetna Medicare Advantage	$2,042.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,736.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,736.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,361.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,736.08
Rate for Payer: Cigna Commercial	$3,404.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,647.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.22
Rate for Payer: UnitedHealthcare Community & State	$215.14
Rate for Payer: Wellpoint Medicaid Managed Care	$193.35

SHELL TRID TRITA CLUSHLE 60MM

Facility

$6,808.15

Service Code	HCPCS C1776
Hospital Charge Code	270659458
Hospital Revenue Code	278
Min. Negotiated Rate	$1,021.22
Max. Negotiated Rate	$1,647.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,361.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,647.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.22

SHELL TRITANIUM HEMI S 48MM

Facility

$6,433.45

Service Code	HCPCS C1776
Hospital Charge Code	270682913
Hospital Revenue Code	278
Min. Negotiated Rate	$182.71
Max. Negotiated Rate	$3,216.72
Rate for Payer: Aetna Commercial	$2,444.71
Rate for Payer: Aetna Medicare Advantage	$1,930.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,286.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,640.53
Rate for Payer: Cigna Commercial	$3,216.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,556.89
Rate for Payer: Qualcare PPO/HMO/WC	$965.02
Rate for Payer: UnitedHealthcare Community & State	$203.30
Rate for Payer: Wellpoint Medicaid Managed Care	$182.71

SHELL TRITANIUM HEMI S 48MM

Facility

$6,433.45

Service Code	HCPCS C1776
Hospital Charge Code	270682913
Hospital Revenue Code	278
Min. Negotiated Rate	$965.02
Max. Negotiated Rate	$1,556.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,286.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,556.89
Rate for Payer: Qualcare PPO/HMO/WC	$965.02

SHELL TRITANIUM HEMI S 58MM

Facility

$5,625.90

Service Code	HCPCS C1776
Hospital Charge Code	270681086
Hospital Revenue Code	278
Min. Negotiated Rate	$843.88
Max. Negotiated Rate	$1,361.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.47
Rate for Payer: Qualcare PPO/HMO/WC	$843.88

SHELL TRITANIUM HEMI S 58MM

Facility

$5,625.90

Service Code	HCPCS C1776
Hospital Charge Code	270681086
Hospital Revenue Code	278
Min. Negotiated Rate	$159.78
Max. Negotiated Rate	$2,812.95
Rate for Payer: Aetna Commercial	$2,137.84
Rate for Payer: Aetna Medicare Advantage	$1,687.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.60
Rate for Payer: Cigna Commercial	$2,812.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.47
Rate for Payer: Qualcare PPO/HMO/WC	$843.88
Rate for Payer: UnitedHealthcare Community & State	$177.78
Rate for Payer: Wellpoint Medicaid Managed Care	$159.78

SHELL TRITANIUM HEMISPHER 50MM

Facility

$12,083.50

Service Code	HCPCS C1776
Hospital Charge Code	270680443
Hospital Revenue Code	278
Min. Negotiated Rate	$343.17
Max. Negotiated Rate	$6,041.75
Rate for Payer: Aetna Commercial	$4,591.73
Rate for Payer: Aetna Medicare Advantage	$3,625.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,081.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,081.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,416.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,081.29
Rate for Payer: Cigna Commercial	$6,041.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,924.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,812.53
Rate for Payer: UnitedHealthcare Community & State	$381.84
Rate for Payer: Wellpoint Medicaid Managed Care	$343.17

SHELL TRITANIUM HEMISPHER 50MM

Facility

$12,083.50

Service Code	HCPCS C1776
Hospital Charge Code	270680443
Hospital Revenue Code	278
Min. Negotiated Rate	$1,812.53
Max. Negotiated Rate	$2,924.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,416.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,924.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,812.53

SHELL TRITANIUM HEMISPHER 52MM

Facility

$6,506.50

Service Code	HCPCS C1776
Hospital Charge Code	270671317
Hospital Revenue Code	278
Min. Negotiated Rate	$975.98
Max. Negotiated Rate	$1,574.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,301.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,574.57
Rate for Payer: Qualcare PPO/HMO/WC	$975.98

SHELL TRITANIUM HEMISPHER 52MM

Facility

$6,506.50

Service Code	HCPCS C1776
Hospital Charge Code	270671317
Hospital Revenue Code	278
Min. Negotiated Rate	$184.78
Max. Negotiated Rate	$3,253.25
Rate for Payer: Aetna Commercial	$2,472.47
Rate for Payer: Aetna Medicare Advantage	$1,951.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,659.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,659.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,301.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,659.16
Rate for Payer: Cigna Commercial	$3,253.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,574.57
Rate for Payer: Qualcare PPO/HMO/WC	$975.98
Rate for Payer: UnitedHealthcare Community & State	$205.61
Rate for Payer: Wellpoint Medicaid Managed Care	$184.78

SHELL TRITANIUM HEMISPHER 54MM

Facility

$6,506.50

Service Code	HCPCS C1776
Hospital Charge Code	270676579
Hospital Revenue Code	278
Min. Negotiated Rate	$184.78
Max. Negotiated Rate	$3,253.25
Rate for Payer: Aetna Commercial	$2,472.47
Rate for Payer: Aetna Medicare Advantage	$1,951.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,659.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,659.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,301.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,659.16
Rate for Payer: Cigna Commercial	$3,253.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,574.57
Rate for Payer: Qualcare PPO/HMO/WC	$975.98
Rate for Payer: UnitedHealthcare Community & State	$205.61
Rate for Payer: Wellpoint Medicaid Managed Care	$184.78

SHELL TRITANIUM HEMISPHER 54MM

Facility

$6,506.50

Service Code	HCPCS C1776
Hospital Charge Code	270676579
Hospital Revenue Code	278
Min. Negotiated Rate	$975.98
Max. Negotiated Rate	$1,574.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,301.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,574.57
Rate for Payer: Qualcare PPO/HMO/WC	$975.98

SHEM 2MM HEAD ACRYLIC

Facility

$85.00

Hospital Charge Code	270676914
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$42.50
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$17.00
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

SHEM 2MM HEAD ACRYLIC

Facility

$85.00

Hospital Charge Code	270676914
Hospital Revenue Code	272
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

Know your out-of-pocket cost for care.

All Charges