Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEAD RADIAL 22MMX6.5MMX6MM

Facility

$17,703.15

Service Code	HCPCS C1776
Hospital Charge Code	270695502
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 22MMX6.5MMX6MM

Facility

$17,703.15

Service Code	HCPCS C1776
Hospital Charge Code	270695502
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 22X5.5X3MM

Facility

$17,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270697683
Hospital Revenue Code	278
Min. Negotiated Rate	$2,655.00
Max. Negotiated Rate	$4,283.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,283.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.00

HEAD RADIAL 22X5.5X3MM

Facility

$17,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270697683
Hospital Revenue Code	278
Min. Negotiated Rate	$502.68
Max. Negotiated Rate	$8,850.00
Rate for Payer: Aetna Commercial	$6,726.00
Rate for Payer: Aetna Medicare Advantage	$5,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,513.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,513.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,513.50
Rate for Payer: Cigna Commercial	$8,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,283.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.00
Rate for Payer: UnitedHealthcare Community & State	$559.32
Rate for Payer: Wellpoint Medicaid Managed Care	$502.68

HEAD RADIAl 9.0 X 2.0MM

Facility

$11,585.00

Service Code	HCPCS C1776
Hospital Charge Code	270687186
Hospital Revenue Code	278
Min. Negotiated Rate	$329.01
Max. Negotiated Rate	$5,792.50
Rate for Payer: Aetna Commercial	$4,402.30
Rate for Payer: Aetna Medicare Advantage	$3,475.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,954.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,954.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,317.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,954.18
Rate for Payer: Cigna Commercial	$5,792.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,737.75
Rate for Payer: UnitedHealthcare Community & State	$366.09
Rate for Payer: Wellpoint Medicaid Managed Care	$329.01

HEAD RADIAl 9.0 X 2.0MM

Facility

$11,585.00

Service Code	HCPCS C1776
Hospital Charge Code	270687186
Hospital Revenue Code	278
Min. Negotiated Rate	$1,737.75
Max. Negotiated Rate	$2,803.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,737.75

HEAD RADIAL ALIGN 22MM

Facility

$11,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678336
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

HEAD RADIAL ALIGN 22MM

Facility

$11,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678336
Hospital Revenue Code	278
Min. Negotiated Rate	$333.70
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$4,465.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50
Rate for Payer: UnitedHealthcare Community & State	$371.30
Rate for Payer: Wellpoint Medicaid Managed Care	$333.70

HEAD RADIAL ELBOW 16x22MM

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680735
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

HEAD RADIAL ELBOW 16x22MM

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680735
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

HEAD RADIAL LT SYSTEM 20MM

Facility

$21,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270693319
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 RADIAL LT SYSTEM 20MM

Facility

$21,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270693319
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

HEADREST 7 PILLOW GENTLE 1937

Facility

$35.10

Hospital Charge Code	270631284
Hospital Revenue Code	270
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$5.26
Rate for Payer: Qualcare PPO/HMO/WC	$5.26

HEADREST 7 PILLOW GENTLE 1937

Facility

$35.10

Hospital Charge Code	270631284
Hospital Revenue Code	270
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$17.55
Rate for Payer: Aetna Commercial	$13.34
Rate for Payer: Aetna Medicare Advantage	$10.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.95
Rate for Payer: Cigna Commercial	$17.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.13
Rate for Payer: Oxford Commercial	$7.02
Rate for Payer: Qualcare PPO/HMO/WC	$5.26
Rate for Payer: UnitedHealthcare Commercial	$7.02
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

HEAD RIGHT 22MM TR ANGLED

Facility

$16,125.00

Hospital Charge Code	270666835
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

HEAD RIGHT 22MM TR ANGLED

Facility

$16,125.00

Hospital Charge Code	270666835
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

HEAD RIGHT 24MM TR ANGLED

Facility

$16,125.00

Hospital Charge Code	270666833
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

HEAD RIGHT 24MM TR ANGLED

Facility

$16,125.00

Hospital Charge Code	270666833
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

HEADSET AUTO REGISTRATION ADUL

Facility

$260.00

Hospital Charge Code	270653840
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.60
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$52.00
Rate for Payer: UnitedHealthcare Community & State	$8.22
Rate for Payer: Wellpoint Medicaid Managed Care	$7.38

HEADSET AUTO REGISTRATION ADUL

Facility

$260.00

Hospital Charge Code	270653840
Hospital Revenue Code	270
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

HEAD, SHOULDER RESURF. DIA. 4

Facility

$21,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270680383
Hospital Revenue Code	278
Min. Negotiated Rate	$599.95
Max. Negotiated Rate	$10,562.50
Rate for Payer: Aetna Commercial	$8,027.50
Rate for Payer: Aetna Medicare Advantage	$6,337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,386.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,386.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,386.88
Rate for Payer: Cigna Commercial	$10,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,112.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,168.75
Rate for Payer: UnitedHealthcare Community & State	$667.55
Rate for Payer: Wellpoint Medicaid Managed Care	$599.95

HEAD, SHOULDER RESURF. DIA. 4

Facility

$21,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270680383
Hospital Revenue Code	278
Min. Negotiated Rate	$3,168.75
Max. Negotiated Rate	$5,112.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,112.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,168.75

HEAD SIZ 40 MM LDH PROVISIONAL

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270698604
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

HEAD SIZ 40 MM LDH PROVISIONAL

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270698604
Hospital Revenue Code	278
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$68.16

HEAD SMR SHOULDER 50MM `

Facility

$21,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270679034
Hospital Revenue Code	278
Min. Negotiated Rate	$599.95
Max. Negotiated Rate	$10,562.50
Rate for Payer: Aetna Commercial	$8,027.50
Rate for Payer: Aetna Medicare Advantage	$6,337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,386.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,386.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,386.88
Rate for Payer: Cigna Commercial	$10,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,112.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,168.75
Rate for Payer: UnitedHealthcare Community & State	$667.55
Rate for Payer: Wellpoint Medicaid Managed Care	$599.95

Know your out-of-pocket cost for care.

All Charges