Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STEM PRIMARY EXTEN 11MM L65MM

Facility

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270683577
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

STEM PRIMARY EXTEN 11MM L65MM

Facility

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270683577
Hospital Revenue Code	278
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Community & State	$86.90
Rate for Payer: Wellpoint Medicaid Managed Care	$78.10

STEM PROFEMUR TI 127D SZ1

Facility

$16,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270697656
Hospital Revenue Code	278
Min. Negotiated Rate	$2,431.50
Max. Negotiated Rate	$3,922.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,922.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,431.50

STEM PROFEMUR TI 127D SZ1

Facility

$16,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270697656
Hospital Revenue Code	278
Min. Negotiated Rate	$460.36
Max. Negotiated Rate	$8,105.00
Rate for Payer: Aetna Commercial	$6,159.80
Rate for Payer: Aetna Medicare Advantage	$4,863.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,133.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,133.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,133.55
Rate for Payer: Cigna Commercial	$8,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,922.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,431.50
Rate for Payer: UnitedHealthcare Community & State	$512.24
Rate for Payer: Wellpoint Medicaid Managed Care	$460.36

STEM PROLINE EVOLVE 7.5MM

Facility

$9,225.00

Service Code	HCPCS C1776
Hospital Charge Code	270686806
Hospital Revenue Code	278
Min. Negotiated Rate	$261.99
Max. Negotiated Rate	$4,612.50
Rate for Payer: Aetna Commercial	$3,505.50
Rate for Payer: Aetna Medicare Advantage	$2,767.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,352.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,352.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,352.38
Rate for Payer: Cigna Commercial	$4,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,232.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,383.75
Rate for Payer: UnitedHealthcare Community & State	$291.51
Rate for Payer: Wellpoint Medicaid Managed Care	$261.99

STEM PROLINE EVOLVE 7.5MM

Facility

$9,225.00

Service Code	HCPCS C1776
Hospital Charge Code	270686806
Hospital Revenue Code	278
Min. Negotiated Rate	$1,383.75
Max. Negotiated Rate	$2,232.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,232.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,383.75

STEM PROLINE IMPLANT 6.5MM

Facility

$11,720.00

Hospital Charge Code	270669852
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.00
Max. Negotiated Rate	$2,836.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.00

STEM PROLINE IMPLANT 6.5MM

Facility

$11,720.00

Hospital Charge Code	270669852
Hospital Revenue Code	278
Min. Negotiated Rate	$332.85
Max. Negotiated Rate	$5,860.00
Rate for Payer: Aetna Commercial	$4,453.60
Rate for Payer: Aetna Medicare Advantage	$3,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,988.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,988.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,988.60
Rate for Payer: Cigna Commercial	$5,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.00
Rate for Payer: UnitedHealthcare Community & State	$370.35
Rate for Payer: Wellpoint Medicaid Managed Care	$332.85

STEM PROLINE IMPLANT 8.5MM

Facility

$11,720.00

Hospital Charge Code	270639548
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.00
Max. Negotiated Rate	$2,836.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.00

STEM PROLINE IMPLANT 8.5MM

Facility

$11,720.00

Hospital Charge Code	270639548
Hospital Revenue Code	278
Min. Negotiated Rate	$332.85
Max. Negotiated Rate	$5,860.00
Rate for Payer: Aetna Commercial	$4,453.60
Rate for Payer: Aetna Medicare Advantage	$3,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,988.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,988.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,988.60
Rate for Payer: Cigna Commercial	$5,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.00
Rate for Payer: UnitedHealthcare Community & State	$370.35
Rate for Payer: Wellpoint Medicaid Managed Care	$332.85

STEM PSA STR 14x30MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270677131
Hospital Revenue Code	278
Min. Negotiated Rate	$624.71
Max. Negotiated Rate	$1,007.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71

STEM PSA STR 14x30MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270677131
Hospital Revenue Code	278
Min. Negotiated Rate	$118.28
Max. Negotiated Rate	$2,082.38
Rate for Payer: Aetna Commercial	$1,582.61
Rate for Payer: Aetna Medicare Advantage	$1,249.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,062.01
Rate for Payer: Cigna Commercial	$2,082.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71
Rate for Payer: UnitedHealthcare Community & State	$131.61
Rate for Payer: Wellpoint Medicaid Managed Care	$118.28

STEM PSA STR 14x75MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270676882
Hospital Revenue Code	278
Min. Negotiated Rate	$624.71
Max. Negotiated Rate	$1,007.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71

STEM PSA STR 14x75MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270676882
Hospital Revenue Code	278
Min. Negotiated Rate	$118.28
Max. Negotiated Rate	$2,082.38
Rate for Payer: Aetna Commercial	$1,582.61
Rate for Payer: Aetna Medicare Advantage	$1,249.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,062.01
Rate for Payer: Cigna Commercial	$2,082.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71
Rate for Payer: UnitedHealthcare Community & State	$131.61
Rate for Payer: Wellpoint Medicaid Managed Care	$118.28

STEM PSA STR 18x100MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270676875
Hospital Revenue Code	278
Min. Negotiated Rate	$118.28
Max. Negotiated Rate	$2,082.38
Rate for Payer: Aetna Commercial	$1,582.61
Rate for Payer: Aetna Medicare Advantage	$1,249.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,062.01
Rate for Payer: Cigna Commercial	$2,082.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71
Rate for Payer: UnitedHealthcare Community & State	$131.61
Rate for Payer: Wellpoint Medicaid Managed Care	$118.28

STEM PSA STR 18x100MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270676875
Hospital Revenue Code	278
Min. Negotiated Rate	$624.71
Max. Negotiated Rate	$1,007.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71

STEM PSN LINE 13X135MM

Facility

$12,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270700043
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.75
Max. Negotiated Rate	$3,123.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,581.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,123.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.75

STEM PSN LINE 13X135MM

Facility

$12,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270700043
Hospital Revenue Code	278
Min. Negotiated Rate	$366.50
Max. Negotiated Rate	$6,452.50
Rate for Payer: Aetna Commercial	$4,903.90
Rate for Payer: Aetna Medicare Advantage	$3,871.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,290.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,290.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,290.78
Rate for Payer: Cigna Commercial	$6,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,123.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.75
Rate for Payer: UnitedHealthcare Community & State	$407.80
Rate for Payer: Wellpoint Medicaid Managed Care	$366.50

STEM PSN REV 14 X 75 MM EXT

Facility

$11,672.50

Service Code	HCPCS C1776
Hospital Charge Code	270690106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.88
Max. Negotiated Rate	$2,824.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,334.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,824.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.88

STEM PSN REV 14 X 75 MM EXT

Facility

$11,672.50

Service Code	HCPCS C1776
Hospital Charge Code	270690106
Hospital Revenue Code	278
Min. Negotiated Rate	$331.50
Max. Negotiated Rate	$5,836.25
Rate for Payer: Aetna Commercial	$4,435.55
Rate for Payer: Aetna Medicare Advantage	$3,501.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,976.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,976.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,334.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,976.49
Rate for Payer: Cigna Commercial	$5,836.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,824.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.88
Rate for Payer: UnitedHealthcare Community & State	$368.85
Rate for Payer: Wellpoint Medicaid Managed Care	$331.50

STEM PSN REV 6MM OFFSET EXT 14

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270694283
Hospital Revenue Code	278
Min. Negotiated Rate	$535.34
Max. Negotiated Rate	$9,425.00
Rate for Payer: Aetna Commercial	$7,163.00
Rate for Payer: Aetna Medicare Advantage	$5,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,806.75
Rate for Payer: Cigna Commercial	$9,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50
Rate for Payer: UnitedHealthcare Community & State	$595.66
Rate for Payer: Wellpoint Medicaid Managed Care	$535.34

STEM PSN REV 6MM OFFSET EXT 14

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270694283
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$4,561.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

STEM PSN REV ST SPLINE

Facility

$15,450.00

Service Code	HCPCS C1776
Hospital Charge Code	270692734
Hospital Revenue Code	278
Min. Negotiated Rate	$2,317.50
Max. Negotiated Rate	$3,738.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.50

STEM PSN REV ST SPLINE

Facility

$15,450.00

Service Code	HCPCS C1776
Hospital Charge Code	270692734
Hospital Revenue Code	278
Min. Negotiated Rate	$438.78
Max. Negotiated Rate	$7,725.00
Rate for Payer: Aetna Commercial	$5,871.00
Rate for Payer: Aetna Medicare Advantage	$4,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,939.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,939.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,939.75
Rate for Payer: Cigna Commercial	$7,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.50
Rate for Payer: UnitedHealthcare Community & State	$488.22
Rate for Payer: Wellpoint Medicaid Managed Care	$438.78

STEM -P STD #1

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688765
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

Know your out-of-pocket cost for care.

All Charges