Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CUP SUBTALAR FUSION SM

Facility

$7,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270698255
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$1,923.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50

CUP TM MOD 54 MULTI 62025420

Facility

$11,901.75

Service Code	HCPCS C1776
Hospital Charge Code	270637123
Hospital Revenue Code	278
Min. Negotiated Rate	$338.01
Max. Negotiated Rate	$5,950.88
Rate for Payer: Aetna Commercial	$4,522.66
Rate for Payer: Aetna Medicare Advantage	$3,570.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,034.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,034.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,380.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,034.95
Rate for Payer: Cigna Commercial	$5,950.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,880.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,785.26
Rate for Payer: UnitedHealthcare Community & State	$376.10
Rate for Payer: Wellpoint Medicaid Managed Care	$338.01

CUP TM MOD 54 MULTI 62025420

Facility

$11,901.75

Service Code	HCPCS C1776
Hospital Charge Code	270637123
Hospital Revenue Code	278
Min. Negotiated Rate	$1,785.26
Max. Negotiated Rate	$2,880.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,380.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,880.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,785.26

CUP TM MODULAR 48MM MULTI-

Facility

$8,660.00

Hospital Charge Code	270663509
Hospital Revenue Code	278
Min. Negotiated Rate	$245.94
Max. Negotiated Rate	$4,330.00
Rate for Payer: Aetna Commercial	$3,290.80
Rate for Payer: Aetna Medicare Advantage	$2,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.30
Rate for Payer: Cigna Commercial	$4,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00
Rate for Payer: UnitedHealthcare Community & State	$273.66
Rate for Payer: Wellpoint Medicaid Managed Care	$245.94

CUP TM MODULAR 48MM MULTI-

Facility

$8,660.00

Hospital Charge Code	270663509
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.00
Max. Negotiated Rate	$2,095.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00

CUP VACUUM ASSIST DELIVERY

Facility

$146.56

Hospital Charge Code	270659920
Hospital Revenue Code	272
Min. Negotiated Rate	$21.98
Max. Negotiated Rate	$21.98
Rate for Payer: Qualcare PPO/HMO/WC	$21.98

CUP VACUUM ASSIST DELIVERY

Facility

$146.56

Hospital Charge Code	270659920
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$73.28
Rate for Payer: Aetna Commercial	$55.69
Rate for Payer: Aetna Medicare Advantage	$43.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.37
Rate for Payer: Cigna Commercial	$73.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.11
Rate for Payer: Oxford Commercial	$29.31
Rate for Payer: Qualcare PPO/HMO/WC	$21.98
Rate for Payer: UnitedHealthcare Commercial	$29.31
Rate for Payer: UnitedHealthcare Community & State	$4.63
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

CUP VERSAFIT 48 MM

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685212
Hospital Revenue Code	278
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$268.60
Rate for Payer: Wellpoint Medicaid Managed Care	$241.40

CUP VERSAFIT 48 MM

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685212
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CUP VERSAFIT 48 MM

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685205
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CUP VERSAFIT 48 MM

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270685205
Hospital Revenue Code	278
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$268.60
Rate for Payer: Wellpoint Medicaid Managed Care	$241.40

CUP VERSAFIT 48MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677886
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

CUP VERSAFIT 48MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677886
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 48MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677708
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

CUP VERSAFIT 48MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677708
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 52MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669777
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

CUP VERSAFIT 52MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669777
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 54MM

Facility

$1,987.85

Service Code	HCPCS C1776
Hospital Charge Code	270680131
Hospital Revenue Code	278
Min. Negotiated Rate	$298.18
Max. Negotiated Rate	$481.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$397.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$481.06
Rate for Payer: Qualcare PPO/HMO/WC	$298.18

CUP VERSAFIT 54MM

Facility

$1,987.85

Service Code	HCPCS C1776
Hospital Charge Code	270680131
Hospital Revenue Code	278
Min. Negotiated Rate	$56.45
Max. Negotiated Rate	$993.92
Rate for Payer: Aetna Commercial	$755.38
Rate for Payer: Aetna Medicare Advantage	$596.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$397.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.90
Rate for Payer: Cigna Commercial	$993.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$481.06
Rate for Payer: Qualcare PPO/HMO/WC	$298.18
Rate for Payer: UnitedHealthcare Community & State	$62.82
Rate for Payer: Wellpoint Medicaid Managed Care	$56.45

CUP VERSAFIT 60MM

Facility

$16,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668031
Hospital Revenue Code	278
Min. Negotiated Rate	$468.60
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Community & State	$521.40
Rate for Payer: Wellpoint Medicaid Managed Care	$468.60

CUP VERSAFIT 60MM

Facility

$16,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668031
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CUP VERSAFIT 62MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682090
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

CUP VERSAFIT 62MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682090
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 64MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681947
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

CUP VERSAFIT 64MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681947
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

Know your out-of-pocket cost for care.

All Charges