Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SPERM EVAL-CERVICAL MUCUS PEN

Facility

$70.00

Service Code	HCPCS 89330
Hospital Charge Code	38477065
Hospital Revenue Code	300
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

SPERM EVAL-CERVICAL MUCUS PEN

Facility

$70.00

Service Code	HCPCS 89330
Hospital Charge Code	38477065
Hospital Revenue Code	300
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$28.23
Rate for Payer: Aetna Medicare Advantage	$33.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.65
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: Cigna Medicare Advantage	$10.38
Rate for Payer: Clover Medicare Advantage	$9.86
Rate for Payer: EmblemHealth Commercial	$31.14
Rate for Payer: Humana Medicare Advantage	$10.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.38
Rate for Payer: Wellcare Medicare Advantage	$10.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

SPERM ISOLATION;COMPLEX PREP

Facility

$217.00

Service Code	HCPCS 89261
Hospital Charge Code	38477186
Hospital Revenue Code	300
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$224.58
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.58
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.42
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$6.16

SPERM ISOLATION;COMPLEX PREP

Facility

$217.00

Service Code	HCPCS 89261
Hospital Charge Code	38477186
Hospital Revenue Code	300
Min. Negotiated Rate	$32.55
Max. Negotiated Rate	$32.55
Rate for Payer: Qualcare PPO/HMO/WC	$32.55

SP EVAL TO FIT VOICE PROSTHSIS

Facility

$320.85

Service Code	HCPCS 92597GN
Hospital Charge Code	9100105
Hospital Revenue Code	440
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$121.92
Rate for Payer: Aetna Medicare Advantage	$96.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.82
Rate for Payer: Cigna Commercial	$160.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.42
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.13
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$10.14
Rate for Payer: Wellpoint Medicaid Managed Care	$9.11

SP EVAL TO FIT VOICE PROSTHSIS

Facility

$320.85

Service Code	HCPCS 92597GN
Hospital Charge Code	9100105
Hospital Revenue Code	440
Min. Negotiated Rate	$48.13
Max. Negotiated Rate	$48.13
Rate for Payer: Qualcare PPO/HMO/WC	$48.13

SPHERE FEMUR CEMENTED LEFT 2 +

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681792
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

SPHERE FEMUR CEMENTED LEFT 2 +

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681792
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

SPHERE FEMUR CEMENTED LEFT S4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684584
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

SPHERE FEMUR CEMENTED LEFT S4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684584
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

SPHERE FEMUR CEMENTED LEFT S5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683393
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

SPHERE FEMUR CEMENTED LEFT S5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683393
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

SPHERE FEMUR CEMENTED LEFT S6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683575
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

SPHERE FEMUR CEMENTED LEFT S6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683575
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

SPHERE FEMUR CEMENTED RIGHT 2+

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686700
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

SPHERE FEMUR CEMENTED RIGHT 2+

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686700
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

SPHERE FLEX LEFT 11 MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683632
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

SPHERE FLEX LEFT 11 MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683632
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

SPHERE FLEX LEFT 12MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682052
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

SPHERE FLEX LEFT 12MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682052
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

SPHERE FLEX RIGHT 11 MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684592
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

SPHERE FLEX RIGHT 11 MM S2

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684592
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

SPHERE INSERT 14MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682053
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

SPHERE INSERT 14MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682053
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

SPHERE INSERT 17MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683394
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

Know your out-of-pocket cost for care.

All Charges