Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BMT 360 TIB AUG 67 X 10MM

Facility

$5,670.00

Service Code	HCPCS C1776
Hospital Charge Code	270687530
Hospital Revenue Code	278
Min. Negotiated Rate	$161.03
Max. Negotiated Rate	$2,835.00
Rate for Payer: Aetna Commercial	$2,154.60
Rate for Payer: Aetna Medicare Advantage	$1,701.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,445.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,445.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,445.85
Rate for Payer: Cigna Commercial	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.14
Rate for Payer: Qualcare PPO/HMO/WC	$850.50
Rate for Payer: UnitedHealthcare Community & State	$179.17
Rate for Payer: Wellpoint Medicaid Managed Care	$161.03

BMT 360 TIB AUG 71 X 10MM

Facility

$5,670.00

Service Code	HCPCS C1776
Hospital Charge Code	270687271
Hospital Revenue Code	278
Min. Negotiated Rate	$850.50
Max. Negotiated Rate	$1,372.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.14
Rate for Payer: Qualcare PPO/HMO/WC	$850.50

BMT 360 TIB AUG 71 X 10MM

Facility

$5,670.00

Service Code	HCPCS C1776
Hospital Charge Code	270687271
Hospital Revenue Code	278
Min. Negotiated Rate	$161.03
Max. Negotiated Rate	$2,835.00
Rate for Payer: Aetna Commercial	$2,154.60
Rate for Payer: Aetna Medicare Advantage	$1,701.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,445.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,445.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,445.85
Rate for Payer: Cigna Commercial	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.14
Rate for Payer: Qualcare PPO/HMO/WC	$850.50
Rate for Payer: UnitedHealthcare Community & State	$179.17
Rate for Payer: Wellpoint Medicaid Managed Care	$161.03

BMT 360 TIB TRAY 67MM

Facility

$14,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270687529
Hospital Revenue Code	278
Min. Negotiated Rate	$2,124.00
Max. Negotiated Rate	$3,426.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,832.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,426.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,124.00

BMT 360 TIB TRAY 67MM

Facility

$14,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270687529
Hospital Revenue Code	278
Min. Negotiated Rate	$402.14
Max. Negotiated Rate	$7,080.00
Rate for Payer: Aetna Commercial	$5,380.80
Rate for Payer: Aetna Medicare Advantage	$4,248.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,610.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,610.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,832.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,610.80
Rate for Payer: Cigna Commercial	$7,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,426.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,124.00
Rate for Payer: UnitedHealthcare Community & State	$447.46
Rate for Payer: Wellpoint Medicaid Managed Care	$402.14

BMT 360 TIOB TRAY 71MM

Facility

$14,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270687272
Hospital Revenue Code	278
Min. Negotiated Rate	$2,124.00
Max. Negotiated Rate	$3,426.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,832.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,426.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,124.00

BMT 360 TIOB TRAY 71MM

Facility

$14,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270687272
Hospital Revenue Code	278
Min. Negotiated Rate	$402.14
Max. Negotiated Rate	$7,080.00
Rate for Payer: Aetna Commercial	$5,380.80
Rate for Payer: Aetna Medicare Advantage	$4,248.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,610.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,610.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,832.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,610.80
Rate for Payer: Cigna Commercial	$7,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,426.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,124.00
Rate for Payer: UnitedHealthcare Community & State	$447.46
Rate for Payer: Wellpoint Medicaid Managed Care	$402.14

BMT SMOOTH KNEE STM 14X120

Facility

$7,620.00

Service Code	HCPCS C1776
Hospital Charge Code	270679804
Hospital Revenue Code	278
Min. Negotiated Rate	$216.41
Max. Negotiated Rate	$3,810.00
Rate for Payer: Aetna Commercial	$2,895.60
Rate for Payer: Aetna Medicare Advantage	$2,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,943.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,943.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,943.10
Rate for Payer: Cigna Commercial	$3,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.00
Rate for Payer: UnitedHealthcare Community & State	$240.79
Rate for Payer: Wellpoint Medicaid Managed Care	$216.41

BMT SMOOTH KNEE STM 14X120

Facility

$7,620.00

Service Code	HCPCS C1776
Hospital Charge Code	270679804
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.00
Max. Negotiated Rate	$1,844.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.00

BMT SMOTH KNEE STM

Facility

$7,620.00

Service Code	HCPCS C1776
Hospital Charge Code	270684252
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.00
Max. Negotiated Rate	$1,844.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.00

BMT SMOTH KNEE STM

Facility

$7,620.00

Service Code	HCPCS C1776
Hospital Charge Code	270684252
Hospital Revenue Code	278
Min. Negotiated Rate	$216.41
Max. Negotiated Rate	$3,810.00
Rate for Payer: Aetna Commercial	$2,895.60
Rate for Payer: Aetna Medicare Advantage	$2,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,943.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,943.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,943.10
Rate for Payer: Cigna Commercial	$3,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,844.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.00
Rate for Payer: UnitedHealthcare Community & State	$240.79
Rate for Payer: Wellpoint Medicaid Managed Care	$216.41

BN GFT OSTEOLINK STR 50X10X7MM

Facility

$13,575.00

Service Code	HCPCS C1713
Hospital Charge Code	270699028
Hospital Revenue Code	278
Min. Negotiated Rate	$2,036.25
Max. Negotiated Rate	$3,285.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,036.25

BN GFT OSTEOLINK STR 50X10X7MM

Facility

$13,575.00

Service Code	HCPCS C1713
Hospital Charge Code	270699028
Hospital Revenue Code	278
Min. Negotiated Rate	$385.53
Max. Negotiated Rate	$6,787.50
Rate for Payer: Aetna Commercial	$5,158.50
Rate for Payer: Aetna Medicare Advantage	$4,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,461.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,461.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,461.62
Rate for Payer: Cigna Commercial	$6,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,036.25
Rate for Payer: UnitedHealthcare Community & State	$428.97
Rate for Payer: Wellpoint Medicaid Managed Care	$385.53

BNP

Facility

$239.00

Service Code	HCPCS 83880
Hospital Charge Code	38476795
Hospital Revenue Code	301
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

BNP

Facility

$239.00

Service Code	HCPCS 83880
Hospital Charge Code	38476795
Hospital Revenue Code	301
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$106.79
Rate for Payer: Aetna Medicare Advantage	$127.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$39.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.42
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$39.26
Rate for Payer: Clover Medicare Advantage	$37.30
Rate for Payer: EmblemHealth Commercial	$117.78
Rate for Payer: Humana Medicare Advantage	$40.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$39.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$31.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.26
Rate for Payer: Wellcare Medicare Advantage	$39.26
Rate for Payer: Wellpoint Medicaid Managed Care	$6.79

BOARD SPECIMEN LOCAL

Facility

$100.00

Hospital Charge Code	270601221
Hospital Revenue Code	270
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

BOARD SPECIMEN LOCAL

Facility

$100.00

Hospital Charge Code	270601221
Hospital Revenue Code	270
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

BOBCOCK GRASPER 10 MM

Facility

$1,276.31

Hospital Charge Code	270669360
Hospital Revenue Code	272
Min. Negotiated Rate	$36.25
Max. Negotiated Rate	$638.15
Rate for Payer: Aetna Commercial	$485.00
Rate for Payer: Aetna Medicare Advantage	$382.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.46
Rate for Payer: Cigna Commercial	$638.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.84
Rate for Payer: Oxford Commercial	$255.26
Rate for Payer: Qualcare PPO/HMO/WC	$191.45
Rate for Payer: UnitedHealthcare Commercial	$255.26
Rate for Payer: UnitedHealthcare Community & State	$40.33
Rate for Payer: Wellpoint Medicaid Managed Care	$36.25

BOBCOCK GRASPER 10 MM

Facility

$1,276.31

Hospital Charge Code	270669360
Hospital Revenue Code	272
Min. Negotiated Rate	$191.45
Max. Negotiated Rate	$191.45
Rate for Payer: Qualcare PPO/HMO/WC	$191.45

BOBCOCK GRASPER 5 MM

Facility

$1,251.27

Hospital Charge Code	270669361
Hospital Revenue Code	272
Min. Negotiated Rate	$187.69
Max. Negotiated Rate	$187.69
Rate for Payer: Qualcare PPO/HMO/WC	$187.69

BOBCOCK GRASPER 5 MM

Facility

$1,251.27

Hospital Charge Code	270669361
Hospital Revenue Code	272
Min. Negotiated Rate	$35.54
Max. Negotiated Rate	$625.63
Rate for Payer: Aetna Commercial	$475.48
Rate for Payer: Aetna Medicare Advantage	$375.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$319.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$319.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$319.07
Rate for Payer: Cigna Commercial	$625.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.33
Rate for Payer: Oxford Commercial	$250.25
Rate for Payer: Qualcare PPO/HMO/WC	$187.69
Rate for Payer: UnitedHealthcare Commercial	$250.25
Rate for Payer: UnitedHealthcare Community & State	$39.54
Rate for Payer: Wellpoint Medicaid Managed Care	$35.54

BODY MP XXL PROX 126DEG 35MM

Facility

$17,910.00

Service Code	HCPCS C1776
Hospital Charge Code	270677768
Hospital Revenue Code	278
Min. Negotiated Rate	$2,686.50
Max. Negotiated Rate	$4,334.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,582.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,334.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,686.50

BODY MP XXL PROX 126DEG 35MM

Facility

$17,910.00

Service Code	HCPCS C1776
Hospital Charge Code	270677768
Hospital Revenue Code	278
Min. Negotiated Rate	$508.64
Max. Negotiated Rate	$8,955.00
Rate for Payer: Aetna Commercial	$6,805.80
Rate for Payer: Aetna Medicare Advantage	$5,373.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,567.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,567.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,582.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,567.05
Rate for Payer: Cigna Commercial	$8,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,334.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,686.50
Rate for Payer: UnitedHealthcare Community & State	$565.96
Rate for Payer: Wellpoint Medicaid Managed Care	$508.64

BODY POS CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8981GO
Hospital Charge Code	74203093
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BODY POS CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8981GP
Hospital Charge Code	9109133
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges