Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LINER DM HEAD 28MM

Facility

$9,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270668030
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 DM HEAD 28MM

Facility

$9,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270668030
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 FLAT HC 40 J MPACT

Facility

$10,465.00

Service Code	HCPCS C1776
Hospital Charge Code	270684311
Hospital Revenue Code	278
Min. Negotiated Rate	$297.21
Max. Negotiated Rate	$5,232.50
Rate for Payer: Aetna Commercial	$3,976.70
Rate for Payer: Aetna Medicare Advantage	$3,139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,668.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,668.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,093.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,668.57
Rate for Payer: Cigna Commercial	$5,232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,532.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,569.75
Rate for Payer: UnitedHealthcare Community & State	$330.69
Rate for Payer: Wellpoint Medicaid Managed Care	$297.21

LINER FLAT HC 40 J MPACT

Facility

$10,465.00

Service Code	HCPCS C1776
Hospital Charge Code	270684311
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.75
Max. Negotiated Rate	$2,532.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,093.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,532.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,569.75

LINER FLAT PE HC 36G

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270694024
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 FLAT PE HC 36G

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270694024
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

LINER FREEDOM CONS HD 36MM T1

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270697521
Hospital Revenue Code	278
Min. Negotiated Rate	$224.93
Max. Negotiated Rate	$3,960.00
Rate for Payer: Aetna Commercial	$3,009.60
Rate for Payer: Aetna Medicare Advantage	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.60
Rate for Payer: Cigna Commercial	$3,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00
Rate for Payer: UnitedHealthcare Community & State	$250.27
Rate for Payer: Wellpoint Medicaid Managed Care	$224.93

LINER FREEDOM CONS HD 36MM T1

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270697521
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.00
Max. Negotiated Rate	$1,916.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00

LINER FREEDOM CONST 32MM T1

Facility

$7,530.00

Service Code	HCPCS C1776
Hospital Charge Code	270698812
Hospital Revenue Code	278
Min. Negotiated Rate	$213.85
Max. Negotiated Rate	$3,765.00
Rate for Payer: Aetna Commercial	$2,861.40
Rate for Payer: Aetna Medicare Advantage	$2,259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,920.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,920.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,506.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,920.15
Rate for Payer: Cigna Commercial	$3,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,822.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,129.50
Rate for Payer: UnitedHealthcare Community & State	$237.95
Rate for Payer: Wellpoint Medicaid Managed Care	$213.85

LINER FREEDOM CONST 32MM T1

Facility

$7,530.00

Service Code	HCPCS C1776
Hospital Charge Code	270698812
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.50
Max. Negotiated Rate	$1,822.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,506.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,822.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,129.50

LINER FREEDOM CONST 36 MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692332
Hospital Revenue Code	278
Min. Negotiated Rate	$498.42
Max. Negotiated Rate	$8,775.00
Rate for Payer: Aetna Commercial	$6,669.00
Rate for Payer: Aetna Medicare Advantage	$5,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,475.25
Rate for Payer: Cigna Commercial	$8,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50
Rate for Payer: UnitedHealthcare Community & State	$554.58
Rate for Payer: Wellpoint Medicaid Managed Care	$498.42

LINER FREEDOM CONST 36 MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692332
Hospital Revenue Code	278
Min. Negotiated Rate	$2,632.50
Max. Negotiated Rate	$4,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50

LINER FREEDOM E1 SZ D G7 36MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270697841
Hospital Revenue Code	278
Min. Negotiated Rate	$2,632.50
Max. Negotiated Rate	$4,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50

LINER FREEDOM E1 SZ D G7 36MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270697841
Hospital Revenue Code	278
Min. Negotiated Rate	$498.42
Max. Negotiated Rate	$8,775.00
Rate for Payer: Aetna Commercial	$6,669.00
Rate for Payer: Aetna Medicare Advantage	$5,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,475.25
Rate for Payer: Cigna Commercial	$8,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50
Rate for Payer: UnitedHealthcare Community & State	$554.58
Rate for Payer: Wellpoint Medicaid Managed Care	$498.42

LINER G7 ACETAB SZ C 32MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270698810
Hospital Revenue Code	278
Min. Negotiated Rate	$498.42
Max. Negotiated Rate	$8,775.00
Rate for Payer: Aetna Commercial	$6,669.00
Rate for Payer: Aetna Medicare Advantage	$5,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,475.25
Rate for Payer: Cigna Commercial	$8,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50
Rate for Payer: UnitedHealthcare Community & State	$554.58
Rate for Payer: Wellpoint Medicaid Managed Care	$498.42

LINER G7 ACETAB SZ C 32MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270698810
Hospital Revenue Code	278
Min. Negotiated Rate	$2,632.50
Max. Negotiated Rate	$4,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50

LINER G7 ACET VE HIGHWALL36MME

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698839
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 G7 ACET VE HIGHWALL36MME

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698839
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 G7 DM 36 MM

Facility

$2,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270698554
Hospital Revenue Code	278
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$641.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.30
Rate for Payer: Qualcare PPO/HMO/WC	$397.50

LINER G7 DM 36 MM

Facility

$2,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270698554
Hospital Revenue Code	278
Min. Negotiated Rate	$75.26
Max. Negotiated Rate	$1,325.00
Rate for Payer: Aetna Commercial	$1,007.00
Rate for Payer: Aetna Medicare Advantage	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$675.75
Rate for Payer: Cigna Commercial	$1,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.30
Rate for Payer: Qualcare PPO/HMO/WC	$397.50
Rate for Payer: UnitedHealthcare Community & State	$83.74
Rate for Payer: Wellpoint Medicaid Managed Care	$75.26

LINER G7 DUAL 46 MM G MOBILITY

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683722
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 G7 DUAL 46 MM G MOBILITY

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683722
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 G7 FREEDOM 36 MM SZ G

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270686595
Hospital Revenue Code	278
Min. Negotiated Rate	$2,632.50
Max. Negotiated Rate	$4,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50

LINER G7 FREEDOM 36 MM SZ G

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270686595
Hospital Revenue Code	278
Min. Negotiated Rate	$498.42
Max. Negotiated Rate	$8,775.00
Rate for Payer: Aetna Commercial	$6,669.00
Rate for Payer: Aetna Medicare Advantage	$5,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,475.25
Rate for Payer: Cigna Commercial	$8,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50
Rate for Payer: UnitedHealthcare Community & State	$554.58
Rate for Payer: Wellpoint Medicaid Managed Care	$498.42

LINER G7 FREEDOM E1 36MM SZ D

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270692096
Hospital Revenue Code	278
Min. Negotiated Rate	$2,632.50
Max. Negotiated Rate	$4,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50

Know your out-of-pocket cost for care.

All Charges