Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEAD 28 MM C-TAPER +5 OFFSET

Facility

$4,277.35

Service Code	HCPCS C1776
Hospital Charge Code	270682463
Hospital Revenue Code	278
Min. Negotiated Rate	$121.48
Max. Negotiated Rate	$2,138.68
Rate for Payer: Aetna Commercial	$1,625.39
Rate for Payer: Aetna Medicare Advantage	$1,283.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.72
Rate for Payer: Cigna Commercial	$2,138.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.12
Rate for Payer: Qualcare PPO/HMO/WC	$641.60
Rate for Payer: UnitedHealthcare Community & State	$135.16
Rate for Payer: Wellpoint Medicaid Managed Care	$121.48

HEAD 28MM MORSE TAPER +0

Facility

$4,888.00

Service Code	HCPCS C1776
Hospital Charge Code	270682465
Hospital Revenue Code	278
Min. Negotiated Rate	$138.82
Max. Negotiated Rate	$2,444.00
Rate for Payer: Aetna Commercial	$1,857.44
Rate for Payer: Aetna Medicare Advantage	$1,466.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.44
Rate for Payer: Cigna Commercial	$2,444.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.90
Rate for Payer: Qualcare PPO/HMO/WC	$733.20
Rate for Payer: UnitedHealthcare Community & State	$154.46
Rate for Payer: Wellpoint Medicaid Managed Care	$138.82

HEAD 28MM MORSE TAPER +0

Facility

$4,888.00

Service Code	HCPCS C1776
Hospital Charge Code	270682465
Hospital Revenue Code	278
Min. Negotiated Rate	$733.20
Max. Negotiated Rate	$1,182.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.90
Rate for Payer: Qualcare PPO/HMO/WC	$733.20

HEAD 28MM MORSE TAPER +5 OFFSE

Facility

$4,888.00

Service Code	HCPCS C1776
Hospital Charge Code	270682464
Hospital Revenue Code	278
Min. Negotiated Rate	$138.82
Max. Negotiated Rate	$2,444.00
Rate for Payer: Aetna Commercial	$1,857.44
Rate for Payer: Aetna Medicare Advantage	$1,466.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.44
Rate for Payer: Cigna Commercial	$2,444.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.90
Rate for Payer: Qualcare PPO/HMO/WC	$733.20
Rate for Payer: UnitedHealthcare Community & State	$154.46
Rate for Payer: Wellpoint Medicaid Managed Care	$138.82

HEAD 28MM MORSE TAPER +5 OFFSE

Facility

$4,888.00

Service Code	HCPCS C1776
Hospital Charge Code	270682464
Hospital Revenue Code	278
Min. Negotiated Rate	$733.20
Max. Negotiated Rate	$1,182.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.90
Rate for Payer: Qualcare PPO/HMO/WC	$733.20

HEAD 32mm X +4

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677753
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

HEAD 32mm X +4

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677753
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

HEADACHES WITH MCC

Facility

$54,877.84

Service Code	MSDRG 102
Min. Negotiated Rate	$16,709.60
Max. Negotiated Rate	$54,877.84
Rate for Payer: Aetna Commercial	$40,943.15
Rate for Payer: Aetna Medicare Advantage	$54,877.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,523.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,523.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,589.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,523.05
Rate for Payer: Cigna Commercial	$24,988.22
Rate for Payer: Cigna Medicare Advantage	$17,589.05
Rate for Payer: Clover Medicare Advantage	$16,709.60
Rate for Payer: EmblemHealth Commercial	$52,767.15
Rate for Payer: Humana Medicare Advantage	$18,116.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,589.05
Rate for Payer: Oxford Commercial	$19,750.26
Rate for Payer: UnitedHealthcare Commercial	$26,436.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,589.05
Rate for Payer: Wellcare Medicare Advantage	$17,589.05

HEADACHES WITHOUT MCC

Facility

$45,886.31

Service Code	MSDRG 103
Min. Negotiated Rate	$13,971.79
Max. Negotiated Rate	$45,886.31
Rate for Payer: Aetna Commercial	$34,539.25
Rate for Payer: Aetna Medicare Advantage	$45,886.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,272.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,272.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,707.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,272.20
Rate for Payer: Cigna Commercial	$18,643.64
Rate for Payer: Cigna Medicare Advantage	$14,707.15
Rate for Payer: Clover Medicare Advantage	$13,971.79
Rate for Payer: EmblemHealth Commercial	$44,121.45
Rate for Payer: Humana Medicare Advantage	$15,148.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,707.15
Rate for Payer: Oxford Commercial	$14,735.61
Rate for Payer: UnitedHealthcare Commercial	$19,724.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,707.15
Rate for Payer: Wellcare Medicare Advantage	$14,707.15

HEAD ANATOMIC 26MM LT

Facility

$21,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270693317
Hospital Revenue Code	278
Min. Negotiated Rate	$618.13
Max. Negotiated Rate	$10,882.50
Rate for Payer: Aetna Commercial	$8,270.70
Rate for Payer: Aetna Medicare Advantage	$6,529.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,550.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,550.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,353.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,550.07
Rate for Payer: Cigna Commercial	$10,882.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,267.13
Rate for Payer: Qualcare PPO/HMO/WC	$3,264.75
Rate for Payer: UnitedHealthcare Community & State	$687.77
Rate for Payer: Wellpoint Medicaid Managed Care	$618.13

HEAD ANATOMIC 26MM LT

Facility

$21,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270693317
Hospital Revenue Code	278
Min. Negotiated Rate	$3,264.75
Max. Negotiated Rate	$5,267.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,353.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,267.13
Rate for Payer: Qualcare PPO/HMO/WC	$3,264.75

HEAD ANATOMIC RADIAL 7.0MM

Facility

$12,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270693290
Hospital Revenue Code	278
Min. Negotiated Rate	$1,824.75
Max. Negotiated Rate	$2,943.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,943.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.75

HEAD ANATOMIC RADIAL 7.0MM

Facility

$12,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270693290
Hospital Revenue Code	278
Min. Negotiated Rate	$345.49
Max. Negotiated Rate	$6,082.50
Rate for Payer: Aetna Commercial	$4,622.70
Rate for Payer: Aetna Medicare Advantage	$3,649.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,102.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,102.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,102.07
Rate for Payer: Cigna Commercial	$6,082.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,943.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.75
Rate for Payer: UnitedHealthcare Community & State	$384.41
Rate for Payer: Wellpoint Medicaid Managed Care	$345.49

HEAD BIOLOX DELTA FEM HEAD

Facility

$7,500.00

Hospital Charge Code	270663513
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

HEAD BIOLOX DELTA FEM HEAD

Facility

$7,500.00

Hospital Charge Code	270663513
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

HEAD BIOLOX DELTA OPT FEM 40MM

Facility

$11,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270698590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,710.00
Max. Negotiated Rate	$2,758.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00

HEAD BIOLOX DELTA OPT FEM 40MM

Facility

$11,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270698590
Hospital Revenue Code	278
Min. Negotiated Rate	$323.76
Max. Negotiated Rate	$5,700.00
Rate for Payer: Aetna Commercial	$4,332.00
Rate for Payer: Aetna Medicare Advantage	$3,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,907.00
Rate for Payer: Cigna Commercial	$5,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00
Rate for Payer: UnitedHealthcare Community & State	$360.24
Rate for Payer: Wellpoint Medicaid Managed Care	$323.76

HEAD BIPOLAR 28x48MM

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677254
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

HEAD BIPOLAR 28x48MM

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677254
Hospital Revenue Code	278
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

HEAD BIPOLAR 28x51mm

Facility

$3,000.00

Hospital Charge Code	270675592
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

HEAD BIPOLAR 28x51mm

Facility

$3,000.00

Hospital Charge Code	270675592
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

HEAD BIPOLAR 28x52MM

Facility

$9,500.00

Hospital Charge Code	270677973
Hospital Revenue Code	278
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

HEAD BIPOLAR 28x52MM

Facility

$9,500.00

Hospital Charge Code	270677973
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

HEAD BIPOLAR 28X53MM

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696730
Hospital Revenue Code	278
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

HEAD BIPOLAR 28X53MM

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696730
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

Know your out-of-pocket cost for care.

All Charges