Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SHOULDER REVERSE 38MM

Facility

$7,393.10

Service Code	HCPCS C1776
Hospital Charge Code	270668553
Hospital Revenue Code	278
Min. Negotiated Rate	$209.96
Max. Negotiated Rate	$3,696.55
Rate for Payer: Aetna Commercial	$2,809.38
Rate for Payer: Aetna Medicare Advantage	$2,217.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,885.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,885.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,885.24
Rate for Payer: Cigna Commercial	$3,696.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,789.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.96
Rate for Payer: UnitedHealthcare Community & State	$233.62
Rate for Payer: Wellpoint Medicaid Managed Care	$209.96

SHOULDER REVERSE LINER +6MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270672164
Hospital Revenue Code	278
Min. Negotiated Rate	$146.26
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,957.00
Rate for Payer: Aetna Medicare Advantage	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.25
Rate for Payer: Cigna Commercial	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50
Rate for Payer: UnitedHealthcare Community & State	$162.74
Rate for Payer: Wellpoint Medicaid Managed Care	$146.26

SHOULDER REVERSE LINER +6MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270672164
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

SHOULDER REVERSE LINER STD

Facility

$3,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270672165
Hospital Revenue Code	278
Min. Negotiated Rate	$103.66
Max. Negotiated Rate	$1,825.00
Rate for Payer: Aetna Commercial	$1,387.00
Rate for Payer: Aetna Medicare Advantage	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$930.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$930.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$930.75
Rate for Payer: Cigna Commercial	$1,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.30
Rate for Payer: Qualcare PPO/HMO/WC	$547.50
Rate for Payer: UnitedHealthcare Community & State	$115.34
Rate for Payer: Wellpoint Medicaid Managed Care	$103.66

SHOULDER REVERSE LINER STD

Facility

$3,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270672165
Hospital Revenue Code	278
Min. Negotiated Rate	$547.50
Max. Negotiated Rate	$883.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$730.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.30
Rate for Payer: Qualcare PPO/HMO/WC	$547.50

SHOULDER SURGERY PROCEDURE

Facility

$859.60

Service Code	HCPCS 23929
Hospital Charge Code	16000546
Hospital Revenue Code	360
Min. Negotiated Rate	$128.94
Max. Negotiated Rate	$128.94
Rate for Payer: Qualcare PPO/HMO/WC	$128.94

SHOULDER SURGERY PROCEDURE

Facility

$859.60

Service Code	HCPCS 23929
Hospital Charge Code	16000546
Hospital Revenue Code	360
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,063.04
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.50
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.94
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$27.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$24.41

SHOULDER SUSPENSION KIT

Facility

$279.00

Hospital Charge Code	270335485
Hospital Revenue Code	272
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna Commercial	$106.02
Rate for Payer: Aetna Medicare Advantage	$83.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.14
Rate for Payer: Cigna Commercial	$139.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.54
Rate for Payer: Oxford Commercial	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$41.85
Rate for Payer: UnitedHealthcare Commercial	$55.80
Rate for Payer: UnitedHealthcare Community & State	$8.82
Rate for Payer: Wellpoint Medicaid Managed Care	$7.92

SHOULDER SUSPENSION KIT

Facility

$279.00

Hospital Charge Code	270335485
Hospital Revenue Code	272
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$41.85
Rate for Payer: Qualcare PPO/HMO/WC	$41.85

SHOULDER TM PLATE REVERSE 25MM

Facility

$18,703.10

Service Code	HCPCS C1776
Hospital Charge Code	270696092
Hospital Revenue Code	278
Min. Negotiated Rate	$531.17
Max. Negotiated Rate	$9,351.55
Rate for Payer: Aetna Commercial	$7,107.18
Rate for Payer: Aetna Medicare Advantage	$5,610.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,769.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,769.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,740.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,769.29
Rate for Payer: Cigna Commercial	$9,351.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,526.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,805.47
Rate for Payer: UnitedHealthcare Community & State	$591.02
Rate for Payer: Wellpoint Medicaid Managed Care	$531.17

SHOULDER TM PLATE REVERSE 25MM

Facility

$18,703.10

Service Code	HCPCS C1776
Hospital Charge Code	270696092
Hospital Revenue Code	278
Min. Negotiated Rate	$2,805.47
Max. Negotiated Rate	$4,526.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,740.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,526.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,805.47

SHOULDER TRAY REPAIR SET

Facility

$1,500.00

Hospital Charge Code	270339493
Hospital Revenue Code	272
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

SHOULDER TRAY REPAIR SET

Facility

$1,500.00

Hospital Charge Code	270339493
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$31,594.36

Service Code	APR-DRG 3153
Min. Negotiated Rate	$30,974.86
Max. Negotiated Rate	$31,594.36
Rate for Payer: UnitedHealthcare Community & State	$30,974.86
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$31,594.36
Rate for Payer: Wellpoint Medicaid Managed Care	$30,974.86

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$13,489.11

Service Code	APR-DRG 3151
Min. Negotiated Rate	$13,224.62
Max. Negotiated Rate	$13,489.11
Rate for Payer: UnitedHealthcare Community & State	$13,224.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,489.11
Rate for Payer: Wellpoint Medicaid Managed Care	$13,224.62

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$21,272.17

Service Code	APR-DRG 3152
Min. Negotiated Rate	$20,855.07
Max. Negotiated Rate	$21,272.17
Rate for Payer: UnitedHealthcare Community & State	$20,855.07
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,272.17
Rate for Payer: Wellpoint Medicaid Managed Care	$20,855.07

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$51,328.71

Service Code	APR-DRG 3154
Min. Negotiated Rate	$50,322.26
Max. Negotiated Rate	$51,328.71
Rate for Payer: UnitedHealthcare Community & State	$50,322.26
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$51,328.71
Rate for Payer: Wellpoint Medicaid Managed Care	$50,322.26

SHRIMP IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003G
Hospital Revenue Code	302
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SHRIMP IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003G
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SHRT ARM SPLNT FRRM TO HN

Facility

$614.91

Service Code	HCPCS 29125
Hospital Charge Code	412329125
Hospital Revenue Code	361
Min. Negotiated Rate	$19.43
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.88
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.24
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$19.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06

SHRT ARM SPLNT FRRM TO HN

Facility

$614.91

Service Code	HCPCS 29125
Hospital Charge Code	412329125
Hospital Revenue Code	361
Min. Negotiated Rate	$92.24
Max. Negotiated Rate	$92.24
Rate for Payer: Qualcare PPO/HMO/WC	$92.24

SHRT HUMERAL DIAPHYS CMNTLS -7

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686877
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

SHRT HUMERAL DIAPHYS CMNTLS -7

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686877
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

SHRT LG SPLNT CLF TO FOOT

Facility

$777.42

Service Code	HCPCS 29515
Hospital Charge Code	412329515
Hospital Revenue Code	361
Min. Negotiated Rate	$22.08
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$700.29
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.13
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.61
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$24.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$22.08

SHRT LG SPLNT CLF TO FOOT

Facility

$777.42

Service Code	HCPCS 29515
Hospital Charge Code	412329515
Hospital Revenue Code	361
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$116.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

Know your out-of-pocket cost for care.

All Charges