Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEAD MOD 36 -3 NECK 11363661

Facility

$3,005.00

Service Code	HCPCS C1776
Hospital Charge Code	270638378
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$727.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

HEAD MODR 36 STANDARD 11363662

Facility

$3,005.00

Service Code	HCPCS C1776
Hospital Charge Code	270633050
Hospital Revenue Code	278
Min. Negotiated Rate	$85.34
Max. Negotiated Rate	$1,502.50
Rate for Payer: Aetna Commercial	$1,141.90
Rate for Payer: Aetna Medicare Advantage	$901.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$766.27
Rate for Payer: Cigna Commercial	$1,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75
Rate for Payer: UnitedHealthcare Community & State	$94.96
Rate for Payer: Wellpoint Medicaid Managed Care	$85.34

HEAD MODR 36 STANDARD 11363662

Facility

$3,005.00

Service Code	HCPCS C1776
Hospital Charge Code	270633050
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$727.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

HEAD MOD TYPE B 28MM +0MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677769
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

HEAD MOD TYPE B 28MM +0MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677769
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 MODULA 32mm-3 NECK 163668

Facility

$3,005.00

Service Code	HCPCS C1776
Hospital Charge Code	270640278
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$727.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

HEAD MODULA 32mm-3 NECK 163668

Facility

$3,005.00

Service Code	HCPCS C1776
Hospital Charge Code	270640278
Hospital Revenue Code	278
Min. Negotiated Rate	$85.34
Max. Negotiated Rate	$1,502.50
Rate for Payer: Aetna Commercial	$1,141.90
Rate for Payer: Aetna Medicare Advantage	$901.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$766.27
Rate for Payer: Cigna Commercial	$1,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75
Rate for Payer: UnitedHealthcare Community & State	$94.96
Rate for Payer: Wellpoint Medicaid Managed Care	$85.34

HEAD MODULAR 28mm +3 NECK

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270605342
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 MODULAR 28mm +3 NECK

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270605342
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

HEAD MODULAR 28MM STD NECK

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270605405
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

HEAD MODULAR 28MM STD NECK

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270605405
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 MODULAR CONSTRAIN 36/-9m

Facility

$8,945.00

Service Code	HCPCS C1776
Hospital Charge Code	270686596
Hospital Revenue Code	278
Min. Negotiated Rate	$254.04
Max. Negotiated Rate	$4,472.50
Rate for Payer: Aetna Commercial	$3,399.10
Rate for Payer: Aetna Medicare Advantage	$2,683.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,280.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,280.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,789.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,280.97
Rate for Payer: Cigna Commercial	$4,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,164.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,341.75
Rate for Payer: UnitedHealthcare Community & State	$282.66
Rate for Payer: Wellpoint Medicaid Managed Care	$254.04

HEAD MODULAR CONSTRAIN 36/-9m

Facility

$8,945.00

Service Code	HCPCS C1776
Hospital Charge Code	270686596
Hospital Revenue Code	278
Min. Negotiated Rate	$1,341.75
Max. Negotiated Rate	$2,164.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,789.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,164.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,341.75

HEAD MODULAR FEM 36 MM

Facility

$3,005.00

Service Code	HCPCS C1776
Hospital Charge Code	270632967
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$727.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

HEAD MODULAR FEM 36 MM

Facility

$3,005.00

Service Code	HCPCS C1776
Hospital Charge Code	270632967
Hospital Revenue Code	278
Min. Negotiated Rate	$85.34
Max. Negotiated Rate	$1,502.50
Rate for Payer: Aetna Commercial	$1,141.90
Rate for Payer: Aetna Medicare Advantage	$901.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$766.27
Rate for Payer: Cigna Commercial	$1,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75
Rate for Payer: UnitedHealthcare Community & State	$94.96
Rate for Payer: Wellpoint Medicaid Managed Care	$85.34

HEAD PROLINE IMPLANT 20MM

Facility

$9,860.00

Service Code	HCPCS C1776
Hospital Charge Code	270679303
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.00
Max. Negotiated Rate	$2,386.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.00

HEAD PROLINE IMPLANT 20MM

Facility

$9,860.00

Service Code	HCPCS C1776
Hospital Charge Code	270679303
Hospital Revenue Code	278
Min. Negotiated Rate	$280.02
Max. Negotiated Rate	$4,930.00
Rate for Payer: Aetna Commercial	$3,746.80
Rate for Payer: Aetna Medicare Advantage	$2,958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,514.30
Rate for Payer: Cigna Commercial	$4,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.00
Rate for Payer: UnitedHealthcare Community & State	$311.58
Rate for Payer: Wellpoint Medicaid Managed Care	$280.02

HEAD PROLINE IMPLANT 24MM

Facility

$9,860.00

Hospital Charge Code	270628374
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.00
Max. Negotiated Rate	$2,386.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.00

HEAD PROLINE IMPLANT 24MM

Facility

$9,860.00

Hospital Charge Code	270628374
Hospital Revenue Code	278
Min. Negotiated Rate	$280.02
Max. Negotiated Rate	$4,930.00
Rate for Payer: Aetna Commercial	$3,746.80
Rate for Payer: Aetna Medicare Advantage	$2,958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,514.30
Rate for Payer: Cigna Commercial	$4,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.00
Rate for Payer: UnitedHealthcare Community & State	$311.58
Rate for Payer: Wellpoint Medicaid Managed Care	$280.02

HEAD PROLINE SZ+2 OD 20MM

Facility

$8,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270686805
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

HEAD PROLINE SZ+2 OD 20MM

Facility

$8,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270686805
Hospital Revenue Code	278
Min. Negotiated Rate	$254.89
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$283.61
Rate for Payer: Wellpoint Medicaid Managed Care	$254.89

HEAD RADIAL 19X5.5MM STM 9MM

Facility

$17,703.15

Service Code	HCPCS C1776
Hospital Charge Code	270696685
Hospital Revenue Code	278
Min. Negotiated Rate	$2,655.47
Max. Negotiated Rate	$4,284.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,540.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,284.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.47

HEAD RADIAL 19X5.5MM STM 9MM

Facility

$17,703.15

Service Code	HCPCS C1776
Hospital Charge Code	270696685
Hospital Revenue Code	278
Min. Negotiated Rate	$502.77
Max. Negotiated Rate	$8,851.58
Rate for Payer: Aetna Commercial	$6,727.20
Rate for Payer: Aetna Medicare Advantage	$5,310.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,514.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,540.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,514.30
Rate for Payer: Cigna Commercial	$8,851.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,284.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.47
Rate for Payer: UnitedHealthcare Community & State	$559.42
Rate for Payer: Wellpoint Medicaid Managed Care	$502.77

HEAD RADIAL 22MM RIGT

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270687185
Hospital Revenue Code	278
Min. Negotiated Rate	$529.94
Max. Negotiated Rate	$9,330.00
Rate for Payer: Aetna Commercial	$7,090.80
Rate for Payer: Aetna Medicare Advantage	$5,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,758.30
Rate for Payer: Cigna Commercial	$9,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00
Rate for Payer: UnitedHealthcare Community & State	$589.66
Rate for Payer: Wellpoint Medicaid Managed Care	$529.94

HEAD RADIAL 22MM RIGT

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270687185
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$4,515.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

Know your out-of-pocket cost for care.

All Charges