Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

COMPONENT FEMORAL SZ 8 RM/LL

Facility

$12,100.00

Hospital Charge Code	270668678
Hospital Revenue Code	278
Min. Negotiated Rate	$1,815.00
Max. Negotiated Rate	$2,928.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,928.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,815.00

COMPONENT FEM W/O HEAD 10MM

Facility

$15,645.00

Hospital Charge Code	270677207
Hospital Revenue Code	278
Min. Negotiated Rate	$2,346.75
Max. Negotiated Rate	$3,786.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,786.09
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.75

COMPONENT FEM W/O HEAD 10MM

Facility

$15,645.00

Hospital Charge Code	270677207
Hospital Revenue Code	278
Min. Negotiated Rate	$444.32
Max. Negotiated Rate	$7,822.50
Rate for Payer: Aetna Commercial	$5,945.10
Rate for Payer: Aetna Medicare Advantage	$4,693.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,989.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,989.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,989.47
Rate for Payer: Cigna Commercial	$7,822.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,786.09
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.75
Rate for Payer: UnitedHealthcare Community & State	$494.38
Rate for Payer: Wellpoint Medicaid Managed Care	$444.32

COMPONENT MODULAR HEAD 28MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270608171
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

COMPONENT MODULAR HEAD 28MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270608171
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

COMPONENT TIBIA SZ 3 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677840
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

COMPONENT TIBIA SZ 3 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677840
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 4 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677818
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

COMPONENT TIBIA SZ 4 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677818
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 5 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677947
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

COMPONENT TIBIA SZ 5 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677947
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 5 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678417
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

COMPONENT TIBIA SZ 5 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678417
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 7 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677859
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 7 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677859
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

COMPONENT TIBIA SZ 7 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677868
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

COMPONENT TIBIA SZ 7 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677868
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPOSIX MESH 4X6

Facility

$688.00

Hospital Charge Code	270335677
Hospital Revenue Code	278
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.50
Rate for Payer: Qualcare PPO/HMO/WC	$103.20

COMPOSIX MESH 4X6

Facility

$688.00

Hospital Charge Code	270335677
Hospital Revenue Code	278
Min. Negotiated Rate	$19.54
Max. Negotiated Rate	$344.00
Rate for Payer: Aetna Commercial	$261.44
Rate for Payer: Aetna Medicare Advantage	$206.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.44
Rate for Payer: Cigna Commercial	$344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.50
Rate for Payer: Qualcare PPO/HMO/WC	$103.20
Rate for Payer: UnitedHealthcare Community & State	$21.74
Rate for Payer: Wellpoint Medicaid Managed Care	$19.54

COMPOSIX MESH LG.

Facility

$2,620.00

Hospital Charge Code	270335679
Hospital Revenue Code	278
Min. Negotiated Rate	$74.41
Max. Negotiated Rate	$1,310.00
Rate for Payer: Aetna Commercial	$995.60
Rate for Payer: Aetna Medicare Advantage	$786.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$668.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$668.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$668.10
Rate for Payer: Cigna Commercial	$1,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$634.04
Rate for Payer: Qualcare PPO/HMO/WC	$393.00
Rate for Payer: UnitedHealthcare Community & State	$82.79
Rate for Payer: Wellpoint Medicaid Managed Care	$74.41

COMPOSIX MESH LG.

Facility

$2,620.00

Hospital Charge Code	270335679
Hospital Revenue Code	278
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$634.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$634.04
Rate for Payer: Qualcare PPO/HMO/WC	$393.00

COMPOSIX MESH MED

Facility

$1,616.00

Hospital Charge Code	270335678
Hospital Revenue Code	278
Min. Negotiated Rate	$45.89
Max. Negotiated Rate	$808.00
Rate for Payer: Aetna Commercial	$614.08
Rate for Payer: Aetna Medicare Advantage	$484.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$412.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$412.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$412.08
Rate for Payer: Cigna Commercial	$808.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.07
Rate for Payer: Qualcare PPO/HMO/WC	$242.40
Rate for Payer: UnitedHealthcare Community & State	$51.07
Rate for Payer: Wellpoint Medicaid Managed Care	$45.89

COMPOSIX MESH MED

Facility

$1,616.00

Hospital Charge Code	270335678
Hospital Revenue Code	278
Min. Negotiated Rate	$242.40
Max. Negotiated Rate	$391.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.07
Rate for Payer: Qualcare PPO/HMO/WC	$242.40

COMP PRIMARY STEM 11MM MINI

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270670923
Hospital Revenue Code	278
Min. Negotiated Rate	$2,175.00
Max. Negotiated Rate	$3,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00

COMP PRIMARY STEM 11MM MINI

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270670923
Hospital Revenue Code	278
Min. Negotiated Rate	$411.80
Max. Negotiated Rate	$7,250.00
Rate for Payer: Aetna Commercial	$5,510.00
Rate for Payer: Aetna Medicare Advantage	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,697.50
Rate for Payer: Cigna Commercial	$7,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00
Rate for Payer: UnitedHealthcare Community & State	$458.20
Rate for Payer: Wellpoint Medicaid Managed Care	$411.80

Know your out-of-pocket cost for care.

All Charges