Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

COMPLICATIONS OF TREATMENT WITH MCC

Facility

$77,306.11

Service Code	MSDRG 919
Min. Negotiated Rate	$23,538.72
Max. Negotiated Rate	$77,306.11
Rate for Payer: Aetna Commercial	$56,916.82
Rate for Payer: Aetna Medicare Advantage	$77,306.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50,423.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50,423.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,777.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50,423.10
Rate for Payer: Cigna Commercial	$40,814.02
Rate for Payer: Cigna Medicare Advantage	$24,777.60
Rate for Payer: Clover Medicare Advantage	$23,538.72
Rate for Payer: EmblemHealth Commercial	$74,332.80
Rate for Payer: Humana Medicare Advantage	$25,520.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,777.60
Rate for Payer: Oxford Commercial	$32,258.70
Rate for Payer: UnitedHealthcare Commercial	$43,179.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,777.60
Rate for Payer: Wellcare Medicare Advantage	$24,777.60

COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$41,213.67

Service Code	MSDRG 921
Min. Negotiated Rate	$12,129.61
Max. Negotiated Rate	$41,213.67
Rate for Payer: Aetna Commercial	$31,211.36
Rate for Payer: Aetna Medicare Advantage	$41,213.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,393.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,393.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,209.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,393.50
Rate for Payer: Cigna Commercial	$15,346.50
Rate for Payer: Cigna Medicare Advantage	$13,209.51
Rate for Payer: Clover Medicare Advantage	$12,549.03
Rate for Payer: EmblemHealth Commercial	$39,628.53
Rate for Payer: Humana Medicare Advantage	$13,605.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,209.51
Rate for Payer: Oxford Commercial	$12,129.61
Rate for Payer: UnitedHealthcare Commercial	$16,235.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,209.51
Rate for Payer: Wellcare Medicare Advantage	$13,209.51

COMPLIC REM FB FROM FOOT

Facility

$6,598.80

Service Code	HCPCS 28193
Hospital Charge Code	16000905
Hospital Revenue Code	360
Min. Negotiated Rate	$989.82
Max. Negotiated Rate	$989.82
Rate for Payer: Qualcare PPO/HMO/WC	$989.82

COMPLIC REM FB FROM FOOT

Facility

$6,598.80

Service Code	HCPCS 28193
Hospital Charge Code	16000905
Hospital Revenue Code	360
Min. Negotiated Rate	$187.41
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,715.69
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$989.82
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$208.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$187.41

COMPLX RE>2.5 CM TONG OR MOUTH

Facility

$3,238.00

Service Code	HCPCS 41252
Hospital Charge Code	5780195
Hospital Revenue Code	450
Min. Negotiated Rate	$485.70
Max. Negotiated Rate	$485.70
Rate for Payer: Qualcare PPO/HMO/WC	$485.70

COMPLX RE>2.5 CM TONG OR MOUTH

Facility

$3,238.00

Service Code	HCPCS 41252
Hospital Charge Code	5780195
Hospital Revenue Code	450
Min. Negotiated Rate	$91.96
Max. Negotiated Rate	$1,020.71
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.71
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$841.88
Rate for Payer: Qualcare PPO/HMO/WC	$485.70
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$91.96

COMPLX REP POST 1/3 TONGUE

Facility

$1,453.00

Service Code	HCPCS 41251
Hospital Charge Code	5780190
Hospital Revenue Code	450
Min. Negotiated Rate	$217.95
Max. Negotiated Rate	$217.95
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

COMPLX REP POST 1/3 TONGUE

Facility

$1,453.00

Service Code	HCPCS 41251
Hospital Charge Code	5780190
Hospital Revenue Code	450
Min. Negotiated Rate	$41.27
Max. Negotiated Rate	$1,020.71
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.71
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.78
Rate for Payer: Qualcare PPO/HMO/WC	$217.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellpoint Medicaid Managed Care	$41.27

COMPNT ZIM TIB SZ 5 598805

Facility

$5,529.65

Service Code	HCPCS C1776
Hospital Charge Code	270625220
Hospital Revenue Code	278
Min. Negotiated Rate	$829.45
Max. Negotiated Rate	$1,338.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,105.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,338.18
Rate for Payer: Qualcare PPO/HMO/WC	$829.45

COMPNT ZIM TIB SZ 5 598805

Facility

$5,529.65

Service Code	HCPCS C1776
Hospital Charge Code	270625220
Hospital Revenue Code	278
Min. Negotiated Rate	$157.04
Max. Negotiated Rate	$2,764.82
Rate for Payer: Aetna Commercial	$2,101.27
Rate for Payer: Aetna Medicare Advantage	$1,658.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,410.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,410.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,105.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,410.06
Rate for Payer: Cigna Commercial	$2,764.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,338.18
Rate for Payer: Qualcare PPO/HMO/WC	$829.45
Rate for Payer: UnitedHealthcare Community & State	$174.74
Rate for Payer: Wellpoint Medicaid Managed Care	$157.04

COMPONENT FEMORAL CEMN SZ22 RT

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677984
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

COMPONENT FEMORAL CEMN SZ22 RT

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677984
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

COMPONENT FEMORAL CEMTD SZ1+

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680559
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

COMPONENT FEMORAL CEMTD SZ1+

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680559
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

COMPONENT FEMORAL CEMTD SZ 3 L

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684046
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

COMPONENT FEMORAL CEMTD SZ 3 L

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684046
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

COMPONENT FEMORAL CEMTD SZ3+ R

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677872
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

COMPONENT FEMORAL CEMTD SZ3+ R

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677872
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

COMPONENT FEMORAL CEMTD SZ3 RT

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677545
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

COMPONENT FEMORAL CEMTD SZ3 RT

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677545
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

COMPONENT FEMORAL CEMTD SZ4+ R

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677557
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

COMPONENT FEMORAL CEMTD SZ4+ R

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677557
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

COMPONENT FEMORAL CEMTD SZ6 RT

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677520
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

COMPONENT FEMORAL CEMTD SZ6 RT

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677520
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

COMPONENT FEMORAL PS LEFT 3

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687679
Hospital Revenue Code	278
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

Know your out-of-pocket cost for care.

All Charges