Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LINER ASF 16MM VE RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689751
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 CEMENTLESS MDM 36MM C

Facility

$5,667.00

Service Code	HCPCS C1776
Hospital Charge Code	270682912
Hospital Revenue Code	278
Min. Negotiated Rate	$850.05
Max. Negotiated Rate	$1,371.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,133.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,371.41
Rate for Payer: Qualcare PPO/HMO/WC	$850.05

LINER CEMENTLESS MDM 36MM C

Facility

$5,667.00

Service Code	HCPCS C1776
Hospital Charge Code	270682912
Hospital Revenue Code	278
Min. Negotiated Rate	$160.94
Max. Negotiated Rate	$2,833.50
Rate for Payer: Aetna Commercial	$2,153.46
Rate for Payer: Aetna Medicare Advantage	$1,700.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,445.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,445.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,133.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,445.09
Rate for Payer: Cigna Commercial	$2,833.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,371.41
Rate for Payer: Qualcare PPO/HMO/WC	$850.05
Rate for Payer: UnitedHealthcare Community & State	$179.08
Rate for Payer: Wellpoint Medicaid Managed Care	$160.94

LINER CEMENTLESS MDM 38MM D

Facility

$5,667.00

Service Code	HCPCS C1776
Hospital Charge Code	270681298
Hospital Revenue Code	278
Min. Negotiated Rate	$850.05
Max. Negotiated Rate	$1,371.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,133.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,371.41
Rate for Payer: Qualcare PPO/HMO/WC	$850.05

LINER CEMENTLESS MDM 38MM D

Facility

$5,147.65

Service Code	HCPCS C1776
Hospital Charge Code	270681378
Hospital Revenue Code	278
Min. Negotiated Rate	$146.19
Max. Negotiated Rate	$2,573.82
Rate for Payer: Aetna Commercial	$1,956.11
Rate for Payer: Aetna Medicare Advantage	$1,544.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,312.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,312.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,312.65
Rate for Payer: Cigna Commercial	$2,573.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.73
Rate for Payer: Qualcare PPO/HMO/WC	$772.15
Rate for Payer: UnitedHealthcare Community & State	$162.67
Rate for Payer: Wellpoint Medicaid Managed Care	$146.19

LINER CEMENTLESS MDM 38MM D

Facility

$5,147.65

Service Code	HCPCS C1776
Hospital Charge Code	270681378
Hospital Revenue Code	278
Min. Negotiated Rate	$772.15
Max. Negotiated Rate	$1,245.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.73
Rate for Payer: Qualcare PPO/HMO/WC	$772.15

LINER CEMENTLESS MDM 38MM D

Facility

$5,667.00

Service Code	HCPCS C1776
Hospital Charge Code	270681298
Hospital Revenue Code	278
Min. Negotiated Rate	$160.94
Max. Negotiated Rate	$2,833.50
Rate for Payer: Aetna Commercial	$2,153.46
Rate for Payer: Aetna Medicare Advantage	$1,700.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,445.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,445.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,133.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,445.09
Rate for Payer: Cigna Commercial	$2,833.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,371.41
Rate for Payer: Qualcare PPO/HMO/WC	$850.05
Rate for Payer: UnitedHealthcare Community & State	$179.08
Rate for Payer: Wellpoint Medicaid Managed Care	$160.94

LINER CEMENTLESS MDM 42 MM E

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270646338
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 CEMENTLESS MDM 42 MM E

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270646338
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 CEMENTLESS MDM 46MM F

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270684946
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

LINER CEMENTLESS MDM 46MM F

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270684946
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

LINER CEMENTLESS MDM 48MM G

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671851
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

LINER CEMENTLESS MDM 48MM G

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671851
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

LINER CLUSTER CUP 52 F 52 MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692712
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

LINER CLUSTER CUP 52 F 52 MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

LINER CONNEXION ACETABULAR

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678674
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 CONNEXION ACETABULAR

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678674
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 CONSTRAINED GROUP 3 36MM

Facility

$7,848.00

Hospital Charge Code	270670931
Hospital Revenue Code	278
Min. Negotiated Rate	$222.88
Max. Negotiated Rate	$3,924.00
Rate for Payer: Aetna Commercial	$2,982.24
Rate for Payer: Aetna Medicare Advantage	$2,354.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,001.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,001.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,001.24
Rate for Payer: Cigna Commercial	$3,924.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,899.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.20
Rate for Payer: UnitedHealthcare Community & State	$248.00
Rate for Payer: Wellpoint Medicaid Managed Care	$222.88

LINER CONSTRAINED GROUP 3 36MM

Facility

$7,848.00

Hospital Charge Code	270670931
Hospital Revenue Code	278
Min. Negotiated Rate	$1,177.20
Max. Negotiated Rate	$1,899.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,899.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.20

LINER CONSTRAINED TRI 64x36MM

Facility

$17,943.50

Hospital Charge Code	270675768
Hospital Revenue Code	278
Min. Negotiated Rate	$509.60
Max. Negotiated Rate	$8,971.75
Rate for Payer: Aetna Commercial	$6,818.53
Rate for Payer: Aetna Medicare Advantage	$5,383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,575.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,575.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,588.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,575.59
Rate for Payer: Cigna Commercial	$8,971.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,342.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,691.53
Rate for Payer: UnitedHealthcare Community & State	$567.01
Rate for Payer: Wellpoint Medicaid Managed Care	$509.60

LINER CONSTRAINED TRI 64x36MM

Facility

$17,943.50

Hospital Charge Code	270675768
Hospital Revenue Code	278
Min. Negotiated Rate	$2,691.53
Max. Negotiated Rate	$4,342.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,588.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,342.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,691.53

LINER DM

Facility

$9,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270670740
Hospital Revenue Code	278
Min. Negotiated Rate	$1,473.75
Max. Negotiated Rate	$2,377.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,377.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.75

LINER DM

Facility

$9,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270670740
Hospital Revenue Code	278
Min. Negotiated Rate	$279.03
Max. Negotiated Rate	$4,912.50
Rate for Payer: Aetna Commercial	$3,733.50
Rate for Payer: Aetna Medicare Advantage	$2,947.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,505.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,505.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,965.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,505.38
Rate for Payer: Cigna Commercial	$4,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,377.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.75
Rate for Payer: UnitedHealthcare Community & State	$310.47
Rate for Payer: Wellpoint Medicaid Managed Care	$279.03

LINER DME HEAD 26MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270676062
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

LINER DME HEAD 26MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270676062
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

Know your out-of-pocket cost for care.

All Charges