Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BARTONELLA AB(IGG,M)W/RFL II

Facility

$390.00

Service Code	HCPCS 8661191
Hospital Charge Code	39990083B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BARTONELLA AB(IGG,M)W/RFL III

Facility

$390.00

Service Code	HCPCS 8661191
Hospital Charge Code	39990083C
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BARTONELLA AB(IGG,M)W/RFL III

Facility

$390.00

Service Code	HCPCS 8661191
Hospital Charge Code	39990083C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BARTONELLA AB(IGG,M)W/RFL IV

Facility

$390.00

Service Code	HCPCS 8661191
Hospital Charge Code	39990083D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BARTONELLA AB(IGG,M)W/RFL IV

Facility

$390.00

Service Code	HCPCS 8661191
Hospital Charge Code	39990083D
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BARTONELLA DNA,PCR

Facility

$390.00

Service Code	HCPCS 87471
Hospital Charge Code	39900291
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BARTONELLA DNA,PCR

Facility

$390.00

Service Code	HCPCS 87471
Hospital Charge Code	39900291
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BASE PHALANGEAL MED

Facility

$7,750.00

Hospital Charge Code	270672047
Hospital Revenue Code	278
Min. Negotiated Rate	$220.10
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$244.90
Rate for Payer: Wellpoint Medicaid Managed Care	$220.10

BASE PHALANGEAL MED

Facility

$7,750.00

Hospital Charge Code	270672047
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

BASEPLATE 24MM 20D FULL AUG ST

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699159
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

BASEPLATE 24MM 20D FULL AUG ST

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699159
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

BASEPLATE GLENOID

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270688816
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$2,917.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

BASEPLATE GLENOID

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270688816
Hospital Revenue Code	278
Min. Negotiated Rate	$342.43
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$4,581.85
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62
Rate for Payer: UnitedHealthcare Community & State	$381.02
Rate for Payer: Wellpoint Medicaid Managed Care	$342.43

BASEPLATE GLENOID FIX STD 25MM

Facility

$18,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270700535
Hospital Revenue Code	278
Min. Negotiated Rate	$2,719.50
Max. Negotiated Rate	$4,387.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,626.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,387.46
Rate for Payer: Qualcare PPO/HMO/WC	$2,719.50

BASEPLATE GLENOID FIX STD 25MM

Facility

$18,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270700535
Hospital Revenue Code	278
Min. Negotiated Rate	$514.89
Max. Negotiated Rate	$9,065.00
Rate for Payer: Aetna Commercial	$6,889.40
Rate for Payer: Aetna Medicare Advantage	$5,439.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,623.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,623.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,623.15
Rate for Payer: Cigna Commercial	$9,065.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,387.46
Rate for Payer: Qualcare PPO/HMO/WC	$2,719.50
Rate for Payer: UnitedHealthcare Community & State	$572.91
Rate for Payer: Wellpoint Medicaid Managed Care	$514.89

BASEPLATE GLENOID L

Facility

$8,575.00

Hospital Charge Code	270672415
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID L

Facility

$8,575.00

Hospital Charge Code	270672415
Hospital Revenue Code	278
Min. Negotiated Rate	$243.53
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$3,258.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25
Rate for Payer: UnitedHealthcare Community & State	$270.97
Rate for Payer: Wellpoint Medicaid Managed Care	$243.53

BASEPLATE GLENOID M

Facility

$8,575.00

Hospital Charge Code	270672414
Hospital Revenue Code	278
Min. Negotiated Rate	$243.53
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$3,258.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25
Rate for Payer: UnitedHealthcare Community & State	$270.97
Rate for Payer: Wellpoint Medicaid Managed Care	$243.53

BASEPLATE GLENOID M

Facility

$8,575.00

Hospital Charge Code	270672414
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID RSS

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270689178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,808.62
Max. Negotiated Rate	$2,917.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62

BASEPLATE GLENOID RSS

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270689178
Hospital Revenue Code	278
Min. Negotiated Rate	$342.43
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$4,581.85
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62
Rate for Payer: UnitedHealthcare Community & State	$381.02
Rate for Payer: Wellpoint Medicaid Managed Care	$342.43

BASEPLATE GLENOID RVRS 10X28MM

Facility

$23,385.00

Service Code	HCPCS C1713
Hospital Charge Code	270700596
Hospital Revenue Code	278
Min. Negotiated Rate	$664.13
Max. Negotiated Rate	$11,692.50
Rate for Payer: Aetna Commercial	$8,886.30
Rate for Payer: Aetna Medicare Advantage	$7,015.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,963.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,963.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,677.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,963.18
Rate for Payer: Cigna Commercial	$11,692.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,659.17
Rate for Payer: Qualcare PPO/HMO/WC	$3,507.75
Rate for Payer: UnitedHealthcare Community & State	$738.97
Rate for Payer: Wellpoint Medicaid Managed Care	$664.13

BASEPLATE GLENOID RVRS 10X28MM

Facility

$23,385.00

Service Code	HCPCS C1713
Hospital Charge Code	270700596
Hospital Revenue Code	278
Min. Negotiated Rate	$3,507.75
Max. Negotiated Rate	$5,659.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,677.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,659.17
Rate for Payer: Qualcare PPO/HMO/WC	$3,507.75

BASEPLATE GLENOID S

Facility

$8,575.00

Hospital Charge Code	270672413
Hospital Revenue Code	278
Min. Negotiated Rate	$243.53
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$3,258.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25
Rate for Payer: UnitedHealthcare Community & State	$270.97
Rate for Payer: Wellpoint Medicaid Managed Care	$243.53

BASEPLATE GLENOID S

Facility

$8,575.00

Hospital Charge Code	270672413
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

Know your out-of-pocket cost for care.

All Charges