Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STEM FEMORAL SZ3 SN

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677255
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

STEM FEMORAL SZ3 SN

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677255
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

STEM FEMORAL SZ 3 STD 135MM

Facility

$13,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689574
Hospital Revenue Code	278
Min. Negotiated Rate	$369.20
Max. Negotiated Rate	$6,500.00
Rate for Payer: Aetna Commercial	$4,940.00
Rate for Payer: Aetna Medicare Advantage	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,315.00
Rate for Payer: Cigna Commercial	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00
Rate for Payer: UnitedHealthcare Community & State	$410.80
Rate for Payer: Wellpoint Medicaid Managed Care	$369.20

STEM FEMORAL SZ 3 STD 135MM

Facility

$13,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689574
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

STEM FEMORAL SZ4 12/14

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677228
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

STEM FEMORAL SZ4 12/14

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677228
Hospital Revenue Code	278
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$268.60
Rate for Payer: Wellpoint Medicaid Managed Care	$241.40

STEM FEMORAL SZ 4 STD COLLAR

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688630
Hospital Revenue Code	278
Min. Negotiated Rate	$404.70
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$450.30
Rate for Payer: Wellpoint Medicaid Managed Care	$404.70

STEM FEMORAL SZ 4 STD COLLAR

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688630
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

STEM FEMORAL SZ6 12/14

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676884
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STEM FEMORAL SZ6 12/14

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676884
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

STEM FEMORAL SZ 8 120MM TAPER

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693324
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

STEM FEMORAL SZ 8 120MM TAPER

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693324
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

STEM FEMORAL SZ 8 12/14 TAPER

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270689572
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

STEM FEMORAL SZ 8 12/14 TAPER

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270689572
Hospital Revenue Code	278
Min. Negotiated Rate	$404.70
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$450.30
Rate for Payer: Wellpoint Medicaid Managed Care	$404.70

STEMFEMSTDARCOS1PC15X210MMCALC

Facility

$39,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270697341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.05
Max. Negotiated Rate	$19,860.00
Rate for Payer: Aetna Commercial	$15,093.60
Rate for Payer: Aetna Medicare Advantage	$11,916.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,128.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,128.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,944.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,128.60
Rate for Payer: Cigna Commercial	$19,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,612.24
Rate for Payer: Qualcare PPO/HMO/WC	$5,958.00
Rate for Payer: UnitedHealthcare Community & State	$1,255.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1,128.05

STEMFEMSTDARCOS1PC15X210MMCALC

Facility

$39,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270697341
Hospital Revenue Code	278
Min. Negotiated Rate	$5,958.00
Max. Negotiated Rate	$9,612.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,944.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,612.24
Rate for Payer: Qualcare PPO/HMO/WC	$5,958.00

STEM FEM TAP 12/14 SZ3 108MM

Facility

$9,712.50

Service Code	HCPCS C1776
Hospital Charge Code	270698953
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.88
Max. Negotiated Rate	$2,350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,350.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.88

STEM FEM TAP 12/14 SZ3 108MM

Facility

$9,712.50

Service Code	HCPCS C1776
Hospital Charge Code	270698953
Hospital Revenue Code	278
Min. Negotiated Rate	$275.83
Max. Negotiated Rate	$4,856.25
Rate for Payer: Aetna Commercial	$3,690.75
Rate for Payer: Aetna Medicare Advantage	$2,913.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,476.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,476.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,476.69
Rate for Payer: Cigna Commercial	$4,856.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,350.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.88
Rate for Payer: UnitedHealthcare Community & State	$306.92
Rate for Payer: Wellpoint Medicaid Managed Care	$275.83

STEM FEMUR P.S CEMENTED LEFTS3

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681469
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

STEM FEMUR P.S CEMENTED LEFTS3

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681469
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

STEM FEM WAGNER CN 125D 20MM

Facility

$17,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270698589
Hospital Revenue Code	278
Min. Negotiated Rate	$2,619.00
Max. Negotiated Rate	$4,225.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,492.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,225.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,619.00

STEM FEM WAGNER CN 125D 20MM

Facility

$17,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270698589
Hospital Revenue Code	278
Min. Negotiated Rate	$495.86
Max. Negotiated Rate	$8,730.00
Rate for Payer: Aetna Commercial	$6,634.80
Rate for Payer: Aetna Medicare Advantage	$5,238.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,452.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,452.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,492.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,452.30
Rate for Payer: Cigna Commercial	$8,730.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,225.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,619.00
Rate for Payer: UnitedHealthcare Community & State	$551.74
Rate for Payer: Wellpoint Medicaid Managed Care	$495.86

STEM FINNED 14MM

Facility

$5,400.00

Hospital Charge Code	270666200
Hospital Revenue Code	278
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$1,306.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,306.80
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

STEM FINNED 14MM

Facility

$5,400.00

Hospital Charge Code	270666200
Hospital Revenue Code	278
Min. Negotiated Rate	$153.36
Max. Negotiated Rate	$2,700.00
Rate for Payer: Aetna Commercial	$2,052.00
Rate for Payer: Aetna Medicare Advantage	$1,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,377.00
Rate for Payer: Cigna Commercial	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,306.80
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Community & State	$170.64
Rate for Payer: Wellpoint Medicaid Managed Care	$153.36

STEM FINNED 14x80MM

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672168
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$1,456.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

Know your out-of-pocket cost for care.

All Charges