Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEAD SMR SHOULDER 50MM `

Facility

$21,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270679034
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 TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$32,965.03

Service Code	APR-DRG 0554
Min. Negotiated Rate	$32,318.66
Max. Negotiated Rate	$32,965.03
Rate for Payer: UnitedHealthcare Community & State	$32,318.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$32,965.03
Rate for Payer: Wellpoint Medicaid Managed Care	$32,318.66

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$18,341.25

Service Code	APR-DRG 0553
Min. Negotiated Rate	$17,981.62
Max. Negotiated Rate	$18,341.25
Rate for Payer: UnitedHealthcare Community & State	$17,981.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,341.25
Rate for Payer: Wellpoint Medicaid Managed Care	$17,981.62

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$8,493.69

Service Code	APR-DRG 0551
Min. Negotiated Rate	$8,327.15
Max. Negotiated Rate	$8,493.69
Rate for Payer: UnitedHealthcare Community & State	$8,327.15
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,493.69
Rate for Payer: Wellpoint Medicaid Managed Care	$8,327.15

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$12,149.29

Service Code	APR-DRG 0552
Min. Negotiated Rate	$11,911.07
Max. Negotiated Rate	$12,149.29
Rate for Payer: UnitedHealthcare Community & State	$11,911.07
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,149.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11,911.07

HEAD UNIPOLAR 52MM

Facility

$5,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270677230
Hospital Revenue Code	278
Min. Negotiated Rate	$828.75
Max. Negotiated Rate	$1,337.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,337.05
Rate for Payer: Qualcare PPO/HMO/WC	$828.75

HEAD UNIPOLAR 52MM

Facility

$5,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270677230
Hospital Revenue Code	278
Min. Negotiated Rate	$156.91
Max. Negotiated Rate	$2,762.50
Rate for Payer: Aetna Commercial	$2,099.50
Rate for Payer: Aetna Medicare Advantage	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,408.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,408.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,408.88
Rate for Payer: Cigna Commercial	$2,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,337.05
Rate for Payer: Qualcare PPO/HMO/WC	$828.75
Rate for Payer: UnitedHealthcare Community & State	$174.59
Rate for Payer: Wellpoint Medicaid Managed Care	$156.91

HEAD UNIV BIPOLAR 46X26MM

Facility

$2,745.55

Service Code	HCPCS C1776
Hospital Charge Code	270700360
Hospital Revenue Code	278
Min. Negotiated Rate	$77.97
Max. Negotiated Rate	$1,372.78
Rate for Payer: Aetna Commercial	$1,043.31
Rate for Payer: Aetna Medicare Advantage	$823.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$700.12
Rate for Payer: Cigna Commercial	$1,372.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.42
Rate for Payer: Qualcare PPO/HMO/WC	$411.83
Rate for Payer: UnitedHealthcare Community & State	$86.76
Rate for Payer: Wellpoint Medicaid Managed Care	$77.97

HEAD UNIV BIPOLAR 46X26MM

Facility

$2,745.55

Service Code	HCPCS C1776
Hospital Charge Code	270700360
Hospital Revenue Code	278
Min. Negotiated Rate	$411.83
Max. Negotiated Rate	$664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.42
Rate for Payer: Qualcare PPO/HMO/WC	$411.83

HEAD UNIVERSAL

Facility

$8,380.00

Service Code	HCPCS C1776
Hospital Charge Code	270660307
Hospital Revenue Code	278
Min. Negotiated Rate	$1,257.00
Max. Negotiated Rate	$2,027.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,676.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,027.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,257.00

HEAD UNIVERSAL

Facility

$8,380.00

Service Code	HCPCS C1776
Hospital Charge Code	270660307
Hospital Revenue Code	278
Min. Negotiated Rate	$237.99
Max. Negotiated Rate	$4,190.00
Rate for Payer: Aetna Commercial	$3,184.40
Rate for Payer: Aetna Medicare Advantage	$2,514.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,136.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,136.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,676.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,136.90
Rate for Payer: Cigna Commercial	$4,190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,027.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,257.00
Rate for Payer: UnitedHealthcare Community & State	$264.81
Rate for Payer: Wellpoint Medicaid Managed Care	$237.99

HEAD UNIVERSAL 47x28MM

Facility

$2,933.00

Service Code	HCPCS C1776
Hospital Charge Code	270676940
Hospital Revenue Code	278
Min. Negotiated Rate	$439.95
Max. Negotiated Rate	$709.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$586.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$709.79
Rate for Payer: Qualcare PPO/HMO/WC	$439.95

HEAD UNIVERSAL 47x28MM

Facility

$2,933.00

Service Code	HCPCS C1776
Hospital Charge Code	270676940
Hospital Revenue Code	278
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$1,466.50
Rate for Payer: Aetna Commercial	$1,114.54
Rate for Payer: Aetna Medicare Advantage	$879.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$747.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$747.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$586.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$747.91
Rate for Payer: Cigna Commercial	$1,466.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$709.79
Rate for Payer: Qualcare PPO/HMO/WC	$439.95
Rate for Payer: UnitedHealthcare Community & State	$92.68
Rate for Payer: Wellpoint Medicaid Managed Care	$83.30

HEAD UNIVERSAL 49 x 26MM

Facility

$3,763.65

Service Code	HCPCS C1776
Hospital Charge Code	270681701
Hospital Revenue Code	278
Min. Negotiated Rate	$106.89
Max. Negotiated Rate	$1,881.83
Rate for Payer: Aetna Commercial	$1,430.19
Rate for Payer: Aetna Medicare Advantage	$1,129.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$959.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$959.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$752.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$959.73
Rate for Payer: Cigna Commercial	$1,881.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.80
Rate for Payer: Qualcare PPO/HMO/WC	$564.55
Rate for Payer: UnitedHealthcare Community & State	$118.93
Rate for Payer: Wellpoint Medicaid Managed Care	$106.89

HEAD UNIVERSAL 49 x 26MM

Facility

$3,763.65

Service Code	HCPCS C1776
Hospital Charge Code	270681701
Hospital Revenue Code	278
Min. Negotiated Rate	$564.55
Max. Negotiated Rate	$910.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$752.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.80
Rate for Payer: Qualcare PPO/HMO/WC	$564.55

HEAD UNIVERSAL 50x28MM

Facility

$3,770.00

Service Code	HCPCS C1776
Hospital Charge Code	270676560
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$912.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: Qualcare PPO/HMO/WC	$565.50

HEAD UNIVERSAL 50x28MM

Facility

$3,770.00

Service Code	HCPCS C1776
Hospital Charge Code	270676560
Hospital Revenue Code	278
Min. Negotiated Rate	$107.07
Max. Negotiated Rate	$1,885.00
Rate for Payer: Aetna Commercial	$1,432.60
Rate for Payer: Aetna Medicare Advantage	$1,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$961.35
Rate for Payer: Cigna Commercial	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: Qualcare PPO/HMO/WC	$565.50
Rate for Payer: UnitedHealthcare Community & State	$119.13
Rate for Payer: Wellpoint Medicaid Managed Care	$107.07

HEAD UNIVERSAL 54x26MM

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270680587
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

HEAD UNIVERSAL 54x26MM

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270680587
Hospital Revenue Code	278
Min. Negotiated Rate	$159.31
Max. Negotiated Rate	$2,804.75
Rate for Payer: Aetna Commercial	$2,131.61
Rate for Payer: Aetna Medicare Advantage	$1,682.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,430.42
Rate for Payer: Cigna Commercial	$2,804.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42
Rate for Payer: UnitedHealthcare Community & State	$177.26
Rate for Payer: Wellpoint Medicaid Managed Care	$159.31

HEAD UNIVERSAL BIPOL 43X26MM

Facility

$7,675.00

Service Code	HCPCS C1776
Hospital Charge Code	270694418
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.25
Max. Negotiated Rate	$1,857.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,857.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.25

HEAD UNIVERSAL BIPOL 43X26MM

Facility

$7,675.00

Service Code	HCPCS C1776
Hospital Charge Code	270694418
Hospital Revenue Code	278
Min. Negotiated Rate	$217.97
Max. Negotiated Rate	$3,837.50
Rate for Payer: Aetna Commercial	$2,916.50
Rate for Payer: Aetna Medicare Advantage	$2,302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,957.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,957.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,957.12
Rate for Payer: Cigna Commercial	$3,837.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,857.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.25
Rate for Payer: UnitedHealthcare Community & State	$242.53
Rate for Payer: Wellpoint Medicaid Managed Care	$217.97

HEAD UNIVERSAL BIPOLAR 42x26MM

Facility

$2,743.60

Service Code	HCPCS C1776
Hospital Charge Code	270673426
Hospital Revenue Code	278
Min. Negotiated Rate	$411.54
Max. Negotiated Rate	$663.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.95
Rate for Payer: Qualcare PPO/HMO/WC	$411.54

HEAD UNIVERSAL BIPOLAR 42x26MM

Facility

$2,743.60

Service Code	HCPCS C1776
Hospital Charge Code	270673426
Hospital Revenue Code	278
Min. Negotiated Rate	$77.92
Max. Negotiated Rate	$1,371.80
Rate for Payer: Aetna Commercial	$1,042.57
Rate for Payer: Aetna Medicare Advantage	$823.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.62
Rate for Payer: Cigna Commercial	$1,371.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.95
Rate for Payer: Qualcare PPO/HMO/WC	$411.54
Rate for Payer: UnitedHealthcare Community & State	$86.70
Rate for Payer: Wellpoint Medicaid Managed Care	$77.92

HEAD VERSA 46MMX21MMX50MM HUM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687428
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

HEAD VERSA 46MMX21MMX50MM HUM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687428
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

Know your out-of-pocket cost for care.

All Charges