Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LINER ACETABULAR 15DEG. SZ G 3

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679648
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

LINER ACETABULAR 15DEG. SZ G 3

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679648
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

LINER ACETABULAR 36MM

Facility

$9,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270679048
Hospital Revenue Code	278
Min. Negotiated Rate	$1,443.75
Max. Negotiated Rate	$2,329.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,329.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,443.75

LINER ACETABULAR 36MM

Facility

$9,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270679048
Hospital Revenue Code	278
Min. Negotiated Rate	$273.35
Max. Negotiated Rate	$4,812.50
Rate for Payer: Aetna Commercial	$3,657.50
Rate for Payer: Aetna Medicare Advantage	$2,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,454.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,454.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,454.38
Rate for Payer: Cigna Commercial	$4,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,329.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,443.75
Rate for Payer: UnitedHealthcare Community & State	$304.15
Rate for Payer: Wellpoint Medicaid Managed Care	$273.35

LINER ACETABULAR 36MM SZ 25

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270666901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 36MM SZ 25

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270666901
Hospital Revenue Code	278
Min. Negotiated Rate	$263.13
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$3,520.70
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75
Rate for Payer: UnitedHealthcare Community & State	$292.77
Rate for Payer: Wellpoint Medicaid Managed Care	$263.13

LINER ACETABULAR 40MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688349
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

LINER ACETABULAR 40MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688349
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

LINER ACETABULAR 44MM SZ F

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677542
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

LINER ACETABULAR 44MM SZ F

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677542
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

LINER ACETABULAR ALTEX 10 DEG

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689570
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

LINER ACETABULAR ALTEX 10 DEG

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689570
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

LINER ACETABULAR RINGLOC

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270659192
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR RINGLOC

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270659192
Hospital Revenue Code	278
Min. Negotiated Rate	$263.13
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$3,520.70
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75
Rate for Payer: UnitedHealthcare Community & State	$292.77
Rate for Payer: Wellpoint Medicaid Managed Care	$263.13

LINER ACETB G7 VITE HWAL 32MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698333
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

LINER ACETB G7 VITE HWAL 32MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698333
Hospital Revenue Code	278
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

LINER ACETBULAR 36 MM

Facility

$6,000.00

Hospital Charge Code	270703304
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

LINER ACETBULAR 36 MM

Facility

$6,000.00

Hospital Charge Code	270703304
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

LINER ACETEBULAR SIZE 25 36mm

Facility

$5,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270639963
Hospital Revenue Code	278
Min. Negotiated Rate	$864.75
Max. Negotiated Rate	$1,395.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,395.13
Rate for Payer: Qualcare PPO/HMO/WC	$864.75

LINER ACETEBULAR SIZE 25 36mm

Facility

$5,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270639963
Hospital Revenue Code	278
Min. Negotiated Rate	$163.73
Max. Negotiated Rate	$2,882.50
Rate for Payer: Aetna Commercial	$2,190.70
Rate for Payer: Aetna Medicare Advantage	$1,729.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,470.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,470.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,470.08
Rate for Payer: Cigna Commercial	$2,882.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,395.13
Rate for Payer: Qualcare PPO/HMO/WC	$864.75
Rate for Payer: UnitedHealthcare Community & State	$182.17
Rate for Payer: Wellpoint Medicaid Managed Care	$163.73

LINERACETTRIDENTTRX3PE0D40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697850
Hospital Revenue Code	278
Min. Negotiated Rate	$665.14
Max. Negotiated Rate	$1,073.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: Qualcare PPO/HMO/WC	$665.14

LINERACETTRIDENTTRX3PE0D40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697850
Hospital Revenue Code	278
Min. Negotiated Rate	$125.93
Max. Negotiated Rate	$2,217.12
Rate for Payer: Aetna Commercial	$1,685.02
Rate for Payer: Aetna Medicare Advantage	$1,330.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,130.73
Rate for Payer: Cigna Commercial	$2,217.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: Qualcare PPO/HMO/WC	$665.14
Rate for Payer: UnitedHealthcare Community & State	$140.12
Rate for Payer: Wellpoint Medicaid Managed Care	$125.93

LINER ARCOM XL 28mm RINGLOC

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270634778
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

LINER ARCOM XL 28mm RINGLOC

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270634778
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

LINER ASF 16MM VE RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689751
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

Know your out-of-pocket cost for care.

All Charges