Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GLENOSPERE 3MM 36MM

Facility

$7,680.00

Service Code	HCPCS C1776
Hospital Charge Code	270671286
Hospital Revenue Code	278
Min. Negotiated Rate	$1,152.00
Max. Negotiated Rate	$1,858.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,536.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.00

GLENOSPERE 3MM 36MM

Facility

$7,680.00

Service Code	HCPCS C1776
Hospital Charge Code	270671286
Hospital Revenue Code	278
Min. Negotiated Rate	$218.11
Max. Negotiated Rate	$3,840.00
Rate for Payer: Aetna Commercial	$2,918.40
Rate for Payer: Aetna Medicare Advantage	$2,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,958.40
Rate for Payer: Cigna Commercial	$3,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.00
Rate for Payer: UnitedHealthcare Community & State	$242.69
Rate for Payer: Wellpoint Medicaid Managed Care	$218.11

GLENOSPHERE 2MM CON

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270688876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.39
Max. Negotiated Rate	$3,027.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39

GLENOSPHERE 2MM CON

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270688868
Hospital Revenue Code	278
Min. Negotiated Rate	$355.26
Max. Negotiated Rate	$6,254.62
Rate for Payer: Aetna Commercial	$4,753.52
Rate for Payer: Aetna Medicare Advantage	$3,752.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,189.86
Rate for Payer: Cigna Commercial	$6,254.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39
Rate for Payer: UnitedHealthcare Community & State	$395.29
Rate for Payer: Wellpoint Medicaid Managed Care	$355.26

GLENOSPHERE 2MM CON

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270689173
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.39
Max. Negotiated Rate	$3,027.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39

GLENOSPHERE 2MM CON

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270688868
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.39
Max. Negotiated Rate	$3,027.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39

GLENOSPHERE 2MM CON

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270688876
Hospital Revenue Code	278
Min. Negotiated Rate	$355.26
Max. Negotiated Rate	$6,254.62
Rate for Payer: Aetna Commercial	$4,753.52
Rate for Payer: Aetna Medicare Advantage	$3,752.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,189.86
Rate for Payer: Cigna Commercial	$6,254.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39
Rate for Payer: UnitedHealthcare Community & State	$395.29
Rate for Payer: Wellpoint Medicaid Managed Care	$355.26

GLENOSPHERE 2MM CON

Facility

$12,509.25

Service Code	HCPCS C1776
Hospital Charge Code	270689173
Hospital Revenue Code	278
Min. Negotiated Rate	$355.26
Max. Negotiated Rate	$6,254.62
Rate for Payer: Aetna Commercial	$4,753.52
Rate for Payer: Aetna Medicare Advantage	$3,752.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,189.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,501.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,189.86
Rate for Payer: Cigna Commercial	$6,254.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,876.39
Rate for Payer: UnitedHealthcare Community & State	$395.29
Rate for Payer: Wellpoint Medicaid Managed Care	$355.26

GLENOSPHERE 32X24.5

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270696740
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOSPHERE 32X24.5

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270696740
Hospital Revenue Code	278
Min. Negotiated Rate	$504.10
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$6,745.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50
Rate for Payer: UnitedHealthcare Community & State	$560.90
Rate for Payer: Wellpoint Medicaid Managed Care	$504.10

GLENOSPHERE 36

Facility

$10,500.00

Hospital Charge Code	270672424
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

GLENOSPHERE 36

Facility

$10,500.00

Hospital Charge Code	270672424
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

GLENOSPHERE 36 +4 L

Facility

$10,500.00

Hospital Charge Code	270672425
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

GLENOSPHERE 36 +4 L

Facility

$10,500.00

Hospital Charge Code	270672425
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

GLENOSPHERE 36+4 LAT/24

Facility

$10,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270699158
Hospital Revenue Code	278
Min. Negotiated Rate	$288.83
Max. Negotiated Rate	$5,085.00
Rate for Payer: Aetna Commercial	$3,864.60
Rate for Payer: Aetna Medicare Advantage	$3,051.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,593.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,593.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,034.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,593.35
Rate for Payer: Cigna Commercial	$5,085.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,461.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.50
Rate for Payer: UnitedHealthcare Community & State	$321.37
Rate for Payer: Wellpoint Medicaid Managed Care	$288.83

GLENOSPHERE 36+4 LAT/24

Facility

$10,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270699158
Hospital Revenue Code	278
Min. Negotiated Rate	$1,525.50
Max. Negotiated Rate	$2,461.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,034.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,461.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,525.50

GLENOSPHERE 36MM REVERSE SHLDR

Facility

$6,470.00

Service Code	HCPCS C1776
Hospital Charge Code	270687782
Hospital Revenue Code	278
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$3,235.00
Rate for Payer: Aetna Commercial	$2,458.60
Rate for Payer: Aetna Medicare Advantage	$1,941.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,649.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,649.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,649.85
Rate for Payer: Cigna Commercial	$3,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,565.74
Rate for Payer: Qualcare PPO/HMO/WC	$970.50
Rate for Payer: UnitedHealthcare Community & State	$204.45
Rate for Payer: Wellpoint Medicaid Managed Care	$183.75

GLENOSPHERE 36MM REVERSE SHLDR

Facility

$6,470.00

Service Code	HCPCS C1776
Hospital Charge Code	270687782
Hospital Revenue Code	278
Min. Negotiated Rate	$970.50
Max. Negotiated Rate	$1,565.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,294.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,565.74
Rate for Payer: Qualcare PPO/HMO/WC	$970.50

GLENOSPHERE 36 MM X 24.5 MM

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270691623
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOSPHERE 36 MM X 24.5 MM

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270691623
Hospital Revenue Code	278
Min. Negotiated Rate	$504.10
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$6,745.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50
Rate for Payer: UnitedHealthcare Community & State	$560.90
Rate for Payer: Wellpoint Medicaid Managed Care	$504.10

GLENOSPHERE 36 MM X 27 MM

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270691624
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOSPHERE 36 MM X 27 MM

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270691624
Hospital Revenue Code	278
Min. Negotiated Rate	$504.10
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$6,745.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50
Rate for Payer: UnitedHealthcare Community & State	$560.90
Rate for Payer: Wellpoint Medicaid Managed Care	$504.10

GLENOSPHERE 36 X 27

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270687832
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOSPHERE 36 X 27

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270687832
Hospital Revenue Code	278
Min. Negotiated Rate	$504.10
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$6,745.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50
Rate for Payer: UnitedHealthcare Community & State	$560.90
Rate for Payer: Wellpoint Medicaid Managed Care	$504.10

GLENOSPHERE 39

Facility

$10,500.00

Hospital Charge Code	270672426
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

Know your out-of-pocket cost for care.

All Charges