Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SHOULD COMP RVS CNTRL 6.5X20MM

Facility

$300.00

Service Code	HCPCS C1776
Hospital Charge Code	270693794
Hospital Revenue Code	278
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$9.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

SHOULDER 1 VIEW-RT

Facility

$6,601.19

Service Code	HCPCS 73020RT
Hospital Charge Code	94061287
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

SHOULDER 1 VIEW-RT

Facility

$6,601.19

Service Code	HCPCS 73020RT
Hospital Charge Code	94061287
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

SHOULDER 36MM GLENOSPHERE

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270680625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,878.75
Max. Negotiated Rate	$3,031.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75

SHOULDER 36MM GLENOSPHERE

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270680625
Hospital Revenue Code	278
Min. Negotiated Rate	$355.71
Max. Negotiated Rate	$6,262.50
Rate for Payer: Aetna Commercial	$4,759.50
Rate for Payer: Aetna Medicare Advantage	$3,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,193.88
Rate for Payer: Cigna Commercial	$6,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75
Rate for Payer: UnitedHealthcare Community & State	$395.79
Rate for Payer: Wellpoint Medicaid Managed Care	$355.71

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$50,459.45

Service Code	APR-DRG 3224
Min. Negotiated Rate	$49,470.05
Max. Negotiated Rate	$50,459.45
Rate for Payer: UnitedHealthcare Community & State	$49,470.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$50,459.45
Rate for Payer: Wellpoint Medicaid Managed Care	$49,470.05

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$24,683.39

Service Code	APR-DRG 3221
Min. Negotiated Rate	$24,199.40
Max. Negotiated Rate	$24,683.39
Rate for Payer: UnitedHealthcare Community & State	$24,199.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,683.39
Rate for Payer: Wellpoint Medicaid Managed Care	$24,199.40

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$26,636.87

Service Code	APR-DRG 3222
Min. Negotiated Rate	$26,114.58
Max. Negotiated Rate	$26,636.87
Rate for Payer: UnitedHealthcare Community & State	$26,114.58
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,636.87
Rate for Payer: Wellpoint Medicaid Managed Care	$26,114.58

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$35,068.83

Service Code	APR-DRG 3223
Min. Negotiated Rate	$34,381.21
Max. Negotiated Rate	$35,068.83
Rate for Payer: UnitedHealthcare Community & State	$34,381.21
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,068.83
Rate for Payer: Wellpoint Medicaid Managed Care	$34,381.21

SHOULDER,ARTHOSCOPY,DX

Facility

$25,603.80

Service Code	HCPCS 29805
Hospital Charge Code	16000728
Hospital Revenue Code	360
Min. Negotiated Rate	$727.15
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,656.99
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$809.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$727.15

SHOULDER,ARTHOSCOPY,DX

Facility

$25,603.80

Service Code	HCPCS 29805
Hospital Charge Code	16000728
Hospital Revenue Code	360
Min. Negotiated Rate	$3,840.57
Max. Negotiated Rate	$3,840.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57

SHOULDER ARTHOSCOPY KIT

Facility

$647.00

Hospital Charge Code	270338754
Hospital Revenue Code	272
Min. Negotiated Rate	$18.37
Max. Negotiated Rate	$323.50
Rate for Payer: Aetna Commercial	$245.86
Rate for Payer: Aetna Medicare Advantage	$194.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.99
Rate for Payer: Cigna Commercial	$323.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.22
Rate for Payer: Oxford Commercial	$129.40
Rate for Payer: Qualcare PPO/HMO/WC	$97.05
Rate for Payer: UnitedHealthcare Commercial	$129.40
Rate for Payer: UnitedHealthcare Community & State	$20.45
Rate for Payer: Wellpoint Medicaid Managed Care	$18.37

SHOULDER ARTHOSCOPY KIT

Facility

$647.00

Hospital Charge Code	270338754
Hospital Revenue Code	272
Min. Negotiated Rate	$97.05
Max. Negotiated Rate	$97.05
Rate for Payer: Qualcare PPO/HMO/WC	$97.05

SHOULDER ARTHROGRAM INJ

Facility

$272.05

Service Code	HCPCS 23350
Hospital Charge Code	16000676
Hospital Revenue Code	360
Min. Negotiated Rate	$40.81
Max. Negotiated Rate	$40.81
Rate for Payer: Qualcare PPO/HMO/WC	$40.81

SHOULDER ARTHROGRAM INJ

Facility

$272.05

Service Code	HCPCS 23350
Hospital Charge Code	16000676
Hospital Revenue Code	360
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$103.38
Rate for Payer: Aetna Medicare Advantage	$81.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.37
Rate for Payer: Cigna Commercial	$136.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.73
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.81
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$8.60
Rate for Payer: Wellpoint Medicaid Managed Care	$7.73

SHOULDER ARTHROSCOPY/SURGER-RT

Facility

$50,586.00

Service Code	HCPCS 29807
Hospital Charge Code	16000243
Hospital Revenue Code	360
Min. Negotiated Rate	$7,587.90
Max. Negotiated Rate	$7,587.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90

SHOULDER ARTHROSCOPY/SURGER-RT

Facility

$50,586.00

Service Code	HCPCS 29807
Hospital Charge Code	16000243
Hospital Revenue Code	360
Min. Negotiated Rate	$1,436.64
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,152.36
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,598.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,436.64

SHOULDER ARTHROSCOPY/SURGERY

Facility

$26,295.79

Service Code	HCPCS 29820
Hospital Charge Code	16000296
Hospital Revenue Code	360
Min. Negotiated Rate	$3,944.37
Max. Negotiated Rate	$3,944.37
Rate for Payer: Qualcare PPO/HMO/WC	$3,944.37

SHOULDER ARTHROSCOPY/SURGERY

Facility

$26,295.79

Service Code	HCPCS 29820
Hospital Charge Code	16000296
Hospital Revenue Code	360
Min. Negotiated Rate	$746.80
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,836.91
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,944.37
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$830.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$746.80

SHOULDER ARTHROSCOPY/SURGRY-R

Facility

$50,586.00

Service Code	HCPCS 29806
Hospital Charge Code	16000341
Hospital Revenue Code	360
Min. Negotiated Rate	$7,587.90
Max. Negotiated Rate	$7,587.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90

SHOULDER ARTHROSCOPY/SURGRY-R

Facility

$50,586.00

Service Code	HCPCS 29806
Hospital Charge Code	16000341
Hospital Revenue Code	360
Min. Negotiated Rate	$1,436.64
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,152.36
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,598.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,436.64

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility

$85,160.31

Service Code	MSDRG 511
Min. Negotiated Rate	$25,930.22
Max. Negotiated Rate	$85,160.31
Rate for Payer: Aetna Commercial	$62,510.67
Rate for Payer: Aetna Medicare Advantage	$85,160.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,132.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,132.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,294.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55,132.95
Rate for Payer: Cigna Commercial	$46,356.06
Rate for Payer: Cigna Medicare Advantage	$27,294.97
Rate for Payer: Clover Medicare Advantage	$25,930.22
Rate for Payer: EmblemHealth Commercial	$81,884.91
Rate for Payer: Humana Medicare Advantage	$28,113.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27,294.97
Rate for Payer: Oxford Commercial	$36,639.03
Rate for Payer: UnitedHealthcare Commercial	$49,042.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,294.97
Rate for Payer: Wellcare Medicare Advantage	$27,294.97

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC

Facility

$114,893.03

Service Code	MSDRG 510
Min. Negotiated Rate	$34,983.46
Max. Negotiated Rate	$114,893.03
Rate for Payer: Aetna Commercial	$83,686.65
Rate for Payer: Aetna Medicare Advantage	$114,893.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75,357.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75,357.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$36,824.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75,357.60
Rate for Payer: Cigna Commercial	$67,336.01
Rate for Payer: Cigna Medicare Advantage	$36,824.69
Rate for Payer: Clover Medicare Advantage	$34,983.46
Rate for Payer: EmblemHealth Commercial	$110,474.07
Rate for Payer: Humana Medicare Advantage	$37,929.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$36,824.69
Rate for Payer: Oxford Commercial	$53,221.21
Rate for Payer: UnitedHealthcare Commercial	$71,238.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$36,824.69
Rate for Payer: Wellcare Medicare Advantage	$36,824.69

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$71,764.68

Service Code	MSDRG 512
Min. Negotiated Rate	$21,851.42
Max. Negotiated Rate	$71,764.68
Rate for Payer: Aetna Commercial	$52,970.12
Rate for Payer: Aetna Medicare Advantage	$71,764.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,605.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,605.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,001.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,605.05
Rate for Payer: Cigna Commercial	$36,903.83
Rate for Payer: Cigna Medicare Advantage	$23,001.50
Rate for Payer: Clover Medicare Advantage	$21,851.42
Rate for Payer: EmblemHealth Commercial	$69,004.50
Rate for Payer: Humana Medicare Advantage	$23,691.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,001.50
Rate for Payer: Oxford Commercial	$29,168.15
Rate for Payer: UnitedHealthcare Commercial	$39,042.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,001.50
Rate for Payer: Wellcare Medicare Advantage	$23,001.50

SHOULDER EQUINOXE HUMERAL 0 mm

Facility

$27,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270679728
Hospital Revenue Code	278
Min. Negotiated Rate	$4,181.25
Max. Negotiated Rate	$6,745.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,745.75
Rate for Payer: Qualcare PPO/HMO/WC	$4,181.25

Know your out-of-pocket cost for care.

All Charges