Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SMOOTH LOCK PEG 2.2MM X 20MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681157
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$113.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

SMOOTH LOCK PEG 2.2MM X 22MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681158
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$113.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

SMOOTH LOCK PEG 2.2MM X 22MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681158
Hospital Revenue Code	278
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$177.84
Rate for Payer: Aetna Medicare Advantage	$140.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.34
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20
Rate for Payer: UnitedHealthcare Community & State	$14.79
Rate for Payer: Wellpoint Medicaid Managed Care	$13.29

SMOOTH MOD + PROF XTRA 465CC

Facility

$7,625.00

Hospital Charge Code	270703175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.75
Max. Negotiated Rate	$1,845.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,845.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.75

SMOOTH MOD + PROF XTRA 465CC

Facility

$7,625.00

Hospital Charge Code	270703175
Hospital Revenue Code	278
Min. Negotiated Rate	$216.55
Max. Negotiated Rate	$3,812.50
Rate for Payer: Aetna Commercial	$2,897.50
Rate for Payer: Aetna Medicare Advantage	$2,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,944.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,944.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,944.38
Rate for Payer: Cigna Commercial	$3,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,845.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.75
Rate for Payer: UnitedHealthcare Community & State	$240.95
Rate for Payer: Wellpoint Medicaid Managed Care	$216.55

SMOOTH MUSCLE AB WITH REFLEX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900366
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SMOOTH MUSCLE AB WITH REFLEX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900366
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

SMOOTH MUSCLE ANTIBODIES

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38476066
Hospital Revenue Code	302
Min. Negotiated Rate	$63.15
Max. Negotiated Rate	$63.15
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

SMOOTH MUSCLE ANTIBODIES

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38476066
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$210.50
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$210.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.46
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.96

SMOOTH MUSCLE ANTIBODY SCREEN

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38479408
Hospital Revenue Code	302
Min. Negotiated Rate	$63.15
Max. Negotiated Rate	$63.15
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

SMOOTH MUSCLE ANTIBODY SCREEN

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38479408
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$210.50
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$210.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.46
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.96

SMOOTH PEG LOCKING 2.0X18

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664354
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

SMOOTH PEG LOCKING 2.0X18

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664354
Hospital Revenue Code	278
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$15.64
Rate for Payer: Wellpoint Medicaid Managed Care	$14.06

SMOOTH PINS PAK

Facility

$1,432.75

Hospital Charge Code	270685072
Hospital Revenue Code	272
Min. Negotiated Rate	$40.69
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$544.45
Rate for Payer: Aetna Medicare Advantage	$429.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.35
Rate for Payer: Cigna Commercial	$716.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.51
Rate for Payer: Oxford Commercial	$286.55
Rate for Payer: Qualcare PPO/HMO/WC	$214.91
Rate for Payer: UnitedHealthcare Commercial	$286.55
Rate for Payer: UnitedHealthcare Community & State	$45.27
Rate for Payer: Wellpoint Medicaid Managed Care	$40.69

SMOOTH PINS PAK

Facility

$1,432.75

Hospital Charge Code	270685072
Hospital Revenue Code	272
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$214.91
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

SMR RT SHOULDER LINER SM

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270675949
Hospital Revenue Code	278
Min. Negotiated Rate	$76.25
Max. Negotiated Rate	$1,342.50
Rate for Payer: Aetna Commercial	$1,020.30
Rate for Payer: Aetna Medicare Advantage	$805.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.67
Rate for Payer: Cigna Commercial	$1,342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: Qualcare PPO/HMO/WC	$402.75
Rate for Payer: UnitedHealthcare Community & State	$84.85
Rate for Payer: Wellpoint Medicaid Managed Care	$76.25

SMR RT SHOULDER LINER SM

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270675949
Hospital Revenue Code	278
Min. Negotiated Rate	$402.75
Max. Negotiated Rate	$649.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: Qualcare PPO/HMO/WC	$402.75

SMR SHOULDER HUMERAL BODY

Facility

$9,955.00

Service Code	HCPCS C1776
Hospital Charge Code	270673175
Hospital Revenue Code	278
Min. Negotiated Rate	$282.72
Max. Negotiated Rate	$4,977.50
Rate for Payer: Aetna Commercial	$3,782.90
Rate for Payer: Aetna Medicare Advantage	$2,986.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,538.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,538.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,991.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,538.53
Rate for Payer: Cigna Commercial	$4,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,409.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,493.25
Rate for Payer: UnitedHealthcare Community & State	$314.58
Rate for Payer: Wellpoint Medicaid Managed Care	$282.72

SMR SHOULDER HUMERAL BODY

Facility

$9,955.00

Service Code	HCPCS C1776
Hospital Charge Code	270673175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.25
Max. Negotiated Rate	$2,409.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,991.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,409.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,493.25

SMR SHOULDER REVERSE LINER

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270673176
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

SMR SHOULDER REVERSE LINER

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270673176
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

SMR SHOULDER /SPALLA

Facility

$18,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678828
Hospital Revenue Code	278
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$592.50
Rate for Payer: Wellpoint Medicaid Managed Care	$532.50

SMR SHOULDER /SPALLA

Facility

$18,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678828
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

SM UNI CEMENT RESTRICTOR W/DI

Facility

$927.00

Service Code	HCPCS C1776
Hospital Charge Code	270660305
Hospital Revenue Code	278
Min. Negotiated Rate	$139.05
Max. Negotiated Rate	$224.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.33
Rate for Payer: Qualcare PPO/HMO/WC	$139.05

SM UNI CEMENT RESTRICTOR W/DI

Facility

$927.00

Service Code	HCPCS C1776
Hospital Charge Code	270660305
Hospital Revenue Code	278
Min. Negotiated Rate	$26.33
Max. Negotiated Rate	$463.50
Rate for Payer: Aetna Commercial	$352.26
Rate for Payer: Aetna Medicare Advantage	$278.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.38
Rate for Payer: Cigna Commercial	$463.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.33
Rate for Payer: Qualcare PPO/HMO/WC	$139.05
Rate for Payer: UnitedHealthcare Community & State	$29.29
Rate for Payer: Wellpoint Medicaid Managed Care	$26.33

Know your out-of-pocket cost for care.

All Charges