Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 VIT E NEUTRAL 40MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699205
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 VIT E NEUTRAL 40MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699205
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 VIVA NEUTRAL D 36MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699661
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 VIVA NEUTRAL D 36MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699661
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 HEAD DM 22.2x48MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677711
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 HEAD DM 22.2x48MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677711
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 HEAD DM 28x48MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677707
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 HEAD DM 28x48MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677707
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 HEAD DM 28x52MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270669780
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 HEAD DM 28x52MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270669780
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 HEAD DM 28x54MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270667468
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 HEAD DM 28x54MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270667468
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 HEAD DM 28x62MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270682088
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 HEAD DM 28x62MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270682088
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 HEAD DM 28x64MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681948
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 HEAD DM 28x64MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681948
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 HEAD SIZE EMPOWR 36MM

Facility

$7,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270692713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$1,905.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25

LINER HEAD SIZE EMPOWR 36MM

Facility

$7,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270692713
Hospital Revenue Code	278
Min. Negotiated Rate	$223.65
Max. Negotiated Rate	$3,937.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,362.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,008.12
Rate for Payer: Cigna Commercial	$3,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25
Rate for Payer: UnitedHealthcare Community & State	$248.85
Rate for Payer: Wellpoint Medicaid Managed Care	$223.65

LINER HI WALL 24X36mm RING LOC

Facility

$14,610.00

Service Code	HCPCS C1776
Hospital Charge Code	270665220
Hospital Revenue Code	278
Min. Negotiated Rate	$414.92
Max. Negotiated Rate	$7,305.00
Rate for Payer: Aetna Commercial	$5,551.80
Rate for Payer: Aetna Medicare Advantage	$4,383.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,725.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,725.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,922.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,725.55
Rate for Payer: Cigna Commercial	$7,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,535.62
Rate for Payer: Qualcare PPO/HMO/WC	$2,191.50
Rate for Payer: UnitedHealthcare Community & State	$461.68
Rate for Payer: Wellpoint Medicaid Managed Care	$414.92

LINER HI WALL 24X36mm RING LOC

Facility

$14,610.00

Service Code	HCPCS C1776
Hospital Charge Code	270665220
Hospital Revenue Code	278
Min. Negotiated Rate	$2,191.50
Max. Negotiated Rate	$3,535.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,922.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,535.62
Rate for Payer: Qualcare PPO/HMO/WC	$2,191.50

LINER HOODED TRIO 32/F CC

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683288
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

LINER HOODED TRIO 32/F CC

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683288
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

LINER HUMER 6X36MM 12.5DREVERS

Facility

$13,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270697093
Hospital Revenue Code	278
Min. Negotiated Rate	$2,036.25
Max. Negotiated Rate	$3,285.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,036.25

LINER HUMER 6X36MM 12.5DREVERS

Facility

$13,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270697093
Hospital Revenue Code	278
Min. Negotiated Rate	$385.53
Max. Negotiated Rate	$6,787.50
Rate for Payer: Aetna Commercial	$5,158.50
Rate for Payer: Aetna Medicare Advantage	$4,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,461.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,461.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,461.62
Rate for Payer: Cigna Commercial	$6,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,036.25
Rate for Payer: UnitedHealthcare Community & State	$428.97
Rate for Payer: Wellpoint Medicaid Managed Care	$385.53

Know your out-of-pocket cost for care.

All Charges