Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BODY POS GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G8982GOCL
Hospital Charge Code	74203095CL
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BODY POS GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G8982GOCL
Hospital Charge Code	74203095CL
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 GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G8982GPCL
Hospital Charge Code	84202020CL
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BODY POS GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G8982GPCL
Hospital Charge Code	84202020CL
Hospital Revenue Code	420
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 GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8982GOCM
Hospital Charge Code	74203095CM
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BODY POS GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8982GPCM
Hospital Charge Code	84202020CM
Hospital Revenue Code	420
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 GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8982GOCM
Hospital Charge Code	74203095CM
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 GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G8982GPCM
Hospital Charge Code	84202020CM
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BODY POS GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8982GOCN
Hospital Charge Code	74203095CN
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BODY POS GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8982GPCN
Hospital Charge Code	84202020CN
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BODY POS GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8982GOCN
Hospital Charge Code	74203095CN
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 GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8982GPCN
Hospital Charge Code	84202020CN
Hospital Revenue Code	420
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 STANDARD REVERSE SHOULDER

Facility

$12,318.15

Service Code	HCPCS C1776
Hospital Charge Code	270689616
Hospital Revenue Code	278
Min. Negotiated Rate	$1,847.72
Max. Negotiated Rate	$2,980.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,463.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,980.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,847.72

BODY STANDARD REVERSE SHOULDER

Facility

$12,318.15

Service Code	HCPCS C1776
Hospital Charge Code	270689616
Hospital Revenue Code	278
Min. Negotiated Rate	$349.84
Max. Negotiated Rate	$6,159.07
Rate for Payer: Aetna Commercial	$4,680.90
Rate for Payer: Aetna Medicare Advantage	$3,695.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,141.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,141.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,463.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,141.13
Rate for Payer: Cigna Commercial	$6,159.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,980.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,847.72
Rate for Payer: UnitedHealthcare Community & State	$389.25
Rate for Payer: Wellpoint Medicaid Managed Care	$349.84

BODY XXL PROX 135DEGREESX35mm

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677751
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

BODY XXL PROX 135DEGREESX35mm

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677751
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

BOLDS CEMENT TIBIAL 65mm

Facility

$3,785.00

Hospital Charge Code	270672078
Hospital Revenue Code	278
Min. Negotiated Rate	$107.49
Max. Negotiated Rate	$1,892.50
Rate for Payer: Aetna Commercial	$1,438.30
Rate for Payer: Aetna Medicare Advantage	$1,135.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$965.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$965.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$757.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$965.17
Rate for Payer: Cigna Commercial	$1,892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.97
Rate for Payer: Qualcare PPO/HMO/WC	$567.75
Rate for Payer: UnitedHealthcare Community & State	$119.61
Rate for Payer: Wellpoint Medicaid Managed Care	$107.49

BOLDS CEMENT TIBIAL 65mm

Facility

$3,785.00

Hospital Charge Code	270672078
Hospital Revenue Code	278
Min. Negotiated Rate	$567.75
Max. Negotiated Rate	$915.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$757.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.97
Rate for Payer: Qualcare PPO/HMO/WC	$567.75

BOLT 5 X 120

Facility

$8,195.00

Service Code	HCPCS C1716
Hospital Charge Code	270702617
Hospital Revenue Code	278
Min. Negotiated Rate	$232.74
Max. Negotiated Rate	$2,166.34
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,166.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,166.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,166.34
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,983.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,229.25
Rate for Payer: UnitedHealthcare Community & State	$258.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$232.74

BOLT 5 X 120

Facility

$8,195.00

Service Code	HCPCS C1716
Hospital Charge Code	270702617
Hospital Revenue Code	278
Min. Negotiated Rate	$1,229.25
Max. Negotiated Rate	$1,983.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,639.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,983.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,229.25

BOLT 6MMX 5.25

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Charge Code	270687842
Hospital Revenue Code	278
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$389.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$322.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.62
Rate for Payer: Qualcare PPO/HMO/WC	$241.50

BOLT 6MMX 5.25

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Charge Code	270687842
Hospital Revenue Code	278
Min. Negotiated Rate	$45.72
Max. Negotiated Rate	$805.00
Rate for Payer: Aetna Commercial	$611.80
Rate for Payer: Aetna Medicare Advantage	$483.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.55
Rate for Payer: Cigna Commercial	$805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.62
Rate for Payer: Qualcare PPO/HMO/WC	$241.50
Rate for Payer: UnitedHealthcare Community & State	$50.88
Rate for Payer: Wellpoint Medicaid Managed Care	$45.72

BOLT 8.5X25

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704071
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

BOLT 8.5X25

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704071
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

BOLT 8.5 X30MM

Facility

$5,210.00

Hospital Charge Code	270703005
Hospital Revenue Code	278
Min. Negotiated Rate	$147.96
Max. Negotiated Rate	$2,605.00
Rate for Payer: Aetna Commercial	$1,979.80
Rate for Payer: Aetna Medicare Advantage	$1,563.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.55
Rate for Payer: Cigna Commercial	$2,605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.82
Rate for Payer: Qualcare PPO/HMO/WC	$781.50
Rate for Payer: UnitedHealthcare Community & State	$164.64
Rate for Payer: Wellpoint Medicaid Managed Care	$147.96

Know your out-of-pocket cost for care.

All Charges