Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CUP MODULAR NEUTRAL LINER

Facility

$6,221.55

Hospital Charge Code	270669882
Hospital Revenue Code	278
Min. Negotiated Rate	$933.23
Max. Negotiated Rate	$1,505.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: Qualcare PPO/HMO/WC	$933.23

CUP MODULAR NEUTRAL LINER

Facility

$6,221.55

Hospital Charge Code	270669882
Hospital Revenue Code	278
Min. Negotiated Rate	$176.69
Max. Negotiated Rate	$3,110.78
Rate for Payer: Aetna Commercial	$2,364.19
Rate for Payer: Aetna Medicare Advantage	$1,866.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.50
Rate for Payer: Cigna Commercial	$3,110.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: Qualcare PPO/HMO/WC	$933.23
Rate for Payer: UnitedHealthcare Community & State	$196.60
Rate for Payer: Wellpoint Medicaid Managed Care	$176.69

CUP NOVATION CROWN 36MM

Facility

$4,750.00

Hospital Charge Code	270676368
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

CUP NOVATION CROWN 36MM

Facility

$4,750.00

Hospital Charge Code	270676368
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CUP REMOVAL INNOMED

Facility

$5,000.00

Hospital Charge Code	270675284
Hospital Revenue Code	272
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

CUP REMOVAL INNOMED

Facility

$5,000.00

Hospital Charge Code	270675284
Hospital Revenue Code	272
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

CUP REVERS 36MM

Facility

$8,925.00

Hospital Charge Code	270672292
Hospital Revenue Code	278
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$282.03
Rate for Payer: Wellpoint Medicaid Managed Care	$253.47

CUP REVERS 36MM

Facility

$8,925.00

Hospital Charge Code	270672292
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 36MM +2L

Facility

$8,925.00

Hospital Charge Code	270672293
Hospital Revenue Code	278
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$282.03
Rate for Payer: Wellpoint Medicaid Managed Care	$253.47

CUP REVERS 36MM +2L

Facility

$8,925.00

Hospital Charge Code	270672293
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 36MM +2R

Facility

$8,925.00

Hospital Charge Code	270672294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 36MM +2R

Facility

$8,925.00

Hospital Charge Code	270672294
Hospital Revenue Code	278
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$282.03
Rate for Payer: Wellpoint Medicaid Managed Care	$253.47

CUP REVERS 39MM

Facility

$8,925.00

Hospital Charge Code	270672295
Hospital Revenue Code	278
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$282.03
Rate for Payer: Wellpoint Medicaid Managed Care	$253.47

CUP REVERS 39MM

Facility

$8,925.00

Hospital Charge Code	270672295
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 39MM +2L

Facility

$8,925.00

Hospital Charge Code	270672296
Hospital Revenue Code	278
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$282.03
Rate for Payer: Wellpoint Medicaid Managed Care	$253.47

CUP REVERS 39MM +2L

Facility

$8,925.00

Hospital Charge Code	270672296
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 39MM +2R

Facility

$8,925.00

Hospital Charge Code	270672397
Hospital Revenue Code	278
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$282.03
Rate for Payer: Wellpoint Medicaid Managed Care	$253.47

CUP REVERS 39MM +2R

Facility

$8,925.00

Hospital Charge Code	270672397
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 42MM

Facility

$8,925.00

Hospital Charge Code	270672398
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 42MM

Facility

$8,925.00

Hospital Charge Code	270672398
Hospital Revenue Code	278
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$282.03
Rate for Payer: Wellpoint Medicaid Managed Care	$253.47

CUP REVERS 42MM +2L

Facility

$8,925.00

Hospital Charge Code	270672399
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 42MM +2L

Facility

$8,925.00

Hospital Charge Code	270672399
Hospital Revenue Code	278
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$282.03
Rate for Payer: Wellpoint Medicaid Managed Care	$253.47

CUP REVERS 42MM +2R

Facility

$8,925.00

Hospital Charge Code	270672400
Hospital Revenue Code	278
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$282.03
Rate for Payer: Wellpoint Medicaid Managed Care	$253.47

CUP REVERS 42MM +2R

Facility

$8,925.00

Hospital Charge Code	270672400
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP SUBTALAR FUSION SM

Facility

$7,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270698255
Hospital Revenue Code	278
Min. Negotiated Rate	$225.78
Max. Negotiated Rate	$3,975.00
Rate for Payer: Aetna Commercial	$3,021.00
Rate for Payer: Aetna Medicare Advantage	$2,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,027.25
Rate for Payer: Cigna Commercial	$3,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50
Rate for Payer: UnitedHealthcare Community & State	$251.22
Rate for Payer: Wellpoint Medicaid Managed Care	$225.78

Know your out-of-pocket cost for care.

All Charges