Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SPACER HUMERAL 36MM +6

Facility

$2,450.00

Hospital Charge Code	270672432
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 36MM +6

Facility

$2,450.00

Hospital Charge Code	270672432
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

SPACER HUMERAL 36MM +9

Facility

$2,450.00

Hospital Charge Code	270672433
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 36MM +9

Facility

$2,450.00

Hospital Charge Code	270672433
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

SPACER HUMERAL 39MM +12

Facility

$2,450.00

Hospital Charge Code	270672438
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 39MM +12

Facility

$2,450.00

Hospital Charge Code	270672438
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

SPACER HUMERAL 39MM +15

Facility

$2,450.00

Hospital Charge Code	270672439
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 39MM +15

Facility

$2,450.00

Hospital Charge Code	270672439
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

SPACER HUMERAL 39MM +6

Facility

$2,450.00

Hospital Charge Code	270672436
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 39MM +6

Facility

$2,450.00

Hospital Charge Code	270672436
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

SPACER HUMERAL 39MM +9

Facility

$2,450.00

Hospital Charge Code	270672437
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 39MM +9

Facility

$2,450.00

Hospital Charge Code	270672437
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

SPACER HUMERAL 42MM +12

Facility

$2,450.00

Hospital Charge Code	270672442
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 42MM +12

Facility

$2,450.00

Hospital Charge Code	270672442
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

SPACER HUMERAL 42MM +15

Facility

$2,450.00

Hospital Charge Code	270672443
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 42MM +15

Facility

$2,450.00

Hospital Charge Code	270672443
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

SPACER HUMERAL 42MM +6

Facility

$2,450.00

Hospital Charge Code	270672440
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 42MM +6

Facility

$2,450.00

Hospital Charge Code	270672440
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

SPACER HUMERAL 42MM +9

Facility

$2,450.00

Hospital Charge Code	270672441
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

SPACER HUMERAL 42MM +9

Facility

$2,450.00

Hospital Charge Code	270672441
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL DELTA XTEND 9MM

Facility

$8,560.00

Service Code	HCPCS C1776
Hospital Charge Code	270686438
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.00
Max. Negotiated Rate	$2,071.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,712.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,071.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.00

SPACER HUMERAL DELTA XTEND 9MM

Facility

$8,560.00

Service Code	HCPCS C1776
Hospital Charge Code	270686438
Hospital Revenue Code	278
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$4,280.00
Rate for Payer: Aetna Commercial	$3,252.80
Rate for Payer: Aetna Medicare Advantage	$2,568.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,182.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,182.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,182.80
Rate for Payer: Cigna Commercial	$4,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,071.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.00
Rate for Payer: UnitedHealthcare Community & State	$270.50
Rate for Payer: Wellpoint Medicaid Managed Care	$243.10

SPACER,IDENT ALIFSA 9X38X28,15

Facility

$33,165.00

Hospital Charge Code	270703006
Hospital Revenue Code	278
Min. Negotiated Rate	$941.89
Max. Negotiated Rate	$16,582.50
Rate for Payer: Aetna Commercial	$12,602.70
Rate for Payer: Aetna Medicare Advantage	$9,949.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,457.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,457.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,633.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,457.08
Rate for Payer: Cigna Commercial	$16,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,025.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,974.75
Rate for Payer: UnitedHealthcare Community & State	$1,048.01
Rate for Payer: Wellpoint Medicaid Managed Care	$941.89

SPACER,IDENT ALIFSA 9X38X28,15

Facility

$33,165.00

Hospital Charge Code	270703006
Hospital Revenue Code	278
Min. Negotiated Rate	$4,974.75
Max. Negotiated Rate	$8,025.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,633.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,025.93
Rate for Payer: Qualcare PPO/HMO/WC	$4,974.75

SPACER IDENTITI 6X14X12MM 7D

Facility

$17,190.00

Service Code	HCPCS C1889
Hospital Charge Code	270697765
Hospital Revenue Code	278
Min. Negotiated Rate	$2,578.50
Max. Negotiated Rate	$4,159.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,438.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,159.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,578.50

Know your out-of-pocket cost for care.

All Charges