Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STEM MOD COMPR 14X150MM

Facility

$18,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270697379
Hospital Revenue Code	278
Min. Negotiated Rate	$2,727.00
Max. Negotiated Rate	$4,399.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,636.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,399.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,727.00

STEM MOD COMPR 14X150MM

Facility

$18,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270697379
Hospital Revenue Code	278
Min. Negotiated Rate	$516.31
Max. Negotiated Rate	$9,090.00
Rate for Payer: Aetna Commercial	$6,908.40
Rate for Payer: Aetna Medicare Advantage	$5,454.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,635.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,635.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,636.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,635.90
Rate for Payer: Cigna Commercial	$9,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,399.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,727.00
Rate for Payer: UnitedHealthcare Community & State	$574.49
Rate for Payer: Wellpoint Medicaid Managed Care	$516.31

STEM MODULAR 40mm WITH SCREW

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270646503
Hospital Revenue Code	278
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) NJ Health	$300.00
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	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

STEM MODULAR 40mm WITH SCREW

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270646503
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

STEM MOLD 15 MM x 155MM W/REIN

Facility

$8,495.00

Service Code	HCPCS C1776
Hospital Charge Code	270686605
Hospital Revenue Code	278
Min. Negotiated Rate	$241.26
Max. Negotiated Rate	$4,247.50
Rate for Payer: Aetna Commercial	$3,228.10
Rate for Payer: Aetna Medicare Advantage	$2,548.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,166.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,166.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,166.22
Rate for Payer: Cigna Commercial	$4,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,055.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,274.25
Rate for Payer: UnitedHealthcare Community & State	$268.44
Rate for Payer: Wellpoint Medicaid Managed Care	$241.26

STEM MOLD 15 MM x 155MM W/REIN

Facility

$8,495.00

Service Code	HCPCS C1776
Hospital Charge Code	270686605
Hospital Revenue Code	278
Min. Negotiated Rate	$1,274.25
Max. Negotiated Rate	$2,055.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,055.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,274.25

STEM MOLD 48MM WITH INSERT

Facility

$6,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270646450
Hospital Revenue Code	278
Min. Negotiated Rate	$1,019.25
Max. Negotiated Rate	$1,644.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,644.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.25

STEM MOLD 48MM WITH INSERT

Facility

$6,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270646450
Hospital Revenue Code	278
Min. Negotiated Rate	$192.98
Max. Negotiated Rate	$3,397.50
Rate for Payer: Aetna Commercial	$2,582.10
Rate for Payer: Aetna Medicare Advantage	$2,038.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,732.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,732.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,732.72
Rate for Payer: Cigna Commercial	$3,397.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,644.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.25
Rate for Payer: UnitedHealthcare Community & State	$214.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.98

STEM MP 180x14MM

Facility

$12,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677767
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

STEM MP 180x14MM

Facility

$12,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677767
Hospital Revenue Code	278
Min. Negotiated Rate	$355.00
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$395.00
Rate for Payer: Wellpoint Medicaid Managed Care	$355.00

STEM NECK ANG SZ7 32X130MM127D

Facility

$11,954.55

Service Code	HCPCS C1776
Hospital Charge Code	270695187
Hospital Revenue Code	278
Min. Negotiated Rate	$339.51
Max. Negotiated Rate	$5,977.27
Rate for Payer: Aetna Commercial	$4,542.73
Rate for Payer: Aetna Medicare Advantage	$3,586.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,048.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,048.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,048.41
Rate for Payer: Cigna Commercial	$5,977.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,893.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,793.18
Rate for Payer: UnitedHealthcare Community & State	$377.76
Rate for Payer: Wellpoint Medicaid Managed Care	$339.51

STEM NECK ANG SZ7 32X130MM127D

Facility

$11,954.55

Service Code	HCPCS C1776
Hospital Charge Code	270695187
Hospital Revenue Code	278
Min. Negotiated Rate	$1,793.18
Max. Negotiated Rate	$2,893.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,893.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,793.18

STEM NEXGEN ST EXT 16X145MM

Facility

$6,690.00

Service Code	HCPCS C1776
Hospital Charge Code	270660881
Hospital Revenue Code	278
Min. Negotiated Rate	$1,003.50
Max. Negotiated Rate	$1,618.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,338.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,618.98
Rate for Payer: Qualcare PPO/HMO/WC	$1,003.50

STEM NEXGEN ST EXT 16X145MM

Facility

$6,690.00

Service Code	HCPCS C1776
Hospital Charge Code	270660881
Hospital Revenue Code	278
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$3,345.00
Rate for Payer: Aetna Commercial	$2,542.20
Rate for Payer: Aetna Medicare Advantage	$2,007.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,705.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,705.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,338.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,705.95
Rate for Payer: Cigna Commercial	$3,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,618.98
Rate for Payer: Qualcare PPO/HMO/WC	$1,003.50
Rate for Payer: UnitedHealthcare Community & State	$211.40
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

STEM NEXGEN STRAIGHT 15X145MM

Facility

$5,245.85

Service Code	HCPCS C1776
Hospital Charge Code	270686914
Hospital Revenue Code	278
Min. Negotiated Rate	$148.98
Max. Negotiated Rate	$2,622.93
Rate for Payer: Aetna Commercial	$1,993.42
Rate for Payer: Aetna Medicare Advantage	$1,573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.69
Rate for Payer: Cigna Commercial	$2,622.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.50
Rate for Payer: Qualcare PPO/HMO/WC	$786.88
Rate for Payer: UnitedHealthcare Community & State	$165.77
Rate for Payer: Wellpoint Medicaid Managed Care	$148.98

STEM NEXGEN STRAIGHT 15X145MM

Facility

$5,245.85

Service Code	HCPCS C1776
Hospital Charge Code	270686914
Hospital Revenue Code	278
Min. Negotiated Rate	$786.88
Max. Negotiated Rate	$1,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.50
Rate for Payer: Qualcare PPO/HMO/WC	$786.88

STEM OSSINTERLOCK BOWD W/SCREW

Facility

$9,895.00

Service Code	HCPCS C1713
Hospital Charge Code	270664285
Hospital Revenue Code	278
Min. Negotiated Rate	$1,484.25
Max. Negotiated Rate	$2,394.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,979.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,394.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,484.25

STEM OSSINTERLOCK BOWD W/SCREW

Facility

$9,895.00

Service Code	HCPCS C1713
Hospital Charge Code	270664285
Hospital Revenue Code	278
Min. Negotiated Rate	$281.02
Max. Negotiated Rate	$4,947.50
Rate for Payer: Aetna Commercial	$3,760.10
Rate for Payer: Aetna Medicare Advantage	$2,968.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,523.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,523.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,979.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,523.22
Rate for Payer: Cigna Commercial	$4,947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,394.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,484.25
Rate for Payer: UnitedHealthcare Community & State	$312.68
Rate for Payer: Wellpoint Medicaid Managed Care	$281.02

STEM OSS RESURFACING 6cm RIGHT

Facility

$39,710.00

Hospital Charge Code	270673874
Hospital Revenue Code	278
Min. Negotiated Rate	$1,127.76
Max. Negotiated Rate	$19,855.00
Rate for Payer: Aetna Commercial	$15,089.80
Rate for Payer: Aetna Medicare Advantage	$11,913.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,126.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,126.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,126.05
Rate for Payer: Cigna Commercial	$19,855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,609.82
Rate for Payer: Qualcare PPO/HMO/WC	$5,956.50
Rate for Payer: UnitedHealthcare Community & State	$1,254.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1,127.76

STEM OSS RESURFACING 6cm RIGHT

Facility

$39,710.00

Hospital Charge Code	270673874
Hospital Revenue Code	278
Min. Negotiated Rate	$5,956.50
Max. Negotiated Rate	$9,609.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,942.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,609.82
Rate for Payer: Qualcare PPO/HMO/WC	$5,956.50

STEM PERSONA CEMENTE SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689501
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

STEM PERSONA CEMENTE SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689501
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

STEM PERSONA CEMENTE SZ 6

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689590
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

STEM PERSONA CEMENTE SZ 6

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

STEM PERSONA CEMENTE SZ 7

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686536
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

Know your out-of-pocket cost for care.

All Charges