Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LINER HUMERAL 36 +3

Facility

$5,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270672409
Hospital Revenue Code	278
Min. Negotiated Rate	$144.13
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$160.37
Rate for Payer: Wellpoint Medicaid Managed Care	$144.13

LINER HUMERAL 36 +3

Facility

$5,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270672409
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 36 +3C

Facility

$5,075.00

Hospital Charge Code	270672410
Hospital Revenue Code	278
Min. Negotiated Rate	$144.13
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$160.37
Rate for Payer: Wellpoint Medicaid Managed Care	$144.13

LINER HUMERAL 36 +3C

Facility

$5,075.00

Hospital Charge Code	270672410
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 36 +6

Facility

$5,075.00

Hospital Charge Code	270672411
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 36 +6

Facility

$5,075.00

Hospital Charge Code	270672411
Hospital Revenue Code	278
Min. Negotiated Rate	$144.13
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$160.37
Rate for Payer: Wellpoint Medicaid Managed Care	$144.13

LINER HUMERAL 36 +6C

Facility

$5,075.00

Hospital Charge Code	270672412
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 36 +6C

Facility

$5,075.00

Hospital Charge Code	270672412
Hospital Revenue Code	278
Min. Negotiated Rate	$144.13
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$160.37
Rate for Payer: Wellpoint Medicaid Managed Care	$144.13

LINER HUMERAL 38MM +0MM

Facility

$4,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270668561
Hospital Revenue Code	278
Min. Negotiated Rate	$708.75
Max. Negotiated Rate	$1,143.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: Qualcare PPO/HMO/WC	$708.75

LINER HUMERAL 38MM +0MM

Facility

$4,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270668561
Hospital Revenue Code	278
Min. Negotiated Rate	$134.19
Max. Negotiated Rate	$2,362.50
Rate for Payer: Aetna Commercial	$1,795.50
Rate for Payer: Aetna Medicare Advantage	$1,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,204.88
Rate for Payer: Cigna Commercial	$2,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: Qualcare PPO/HMO/WC	$708.75
Rate for Payer: UnitedHealthcare Community & State	$149.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.19

LINER HUMERAL 38MM +2.5MM

Facility

$4,197.10

Service Code	HCPCS C1776
Hospital Charge Code	270668559
Hospital Revenue Code	278
Min. Negotiated Rate	$629.57
Max. Negotiated Rate	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$839.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,015.70
Rate for Payer: Qualcare PPO/HMO/WC	$629.57

LINER HUMERAL 38MM +2.5MM

Facility

$4,197.10

Service Code	HCPCS C1776
Hospital Charge Code	270668559
Hospital Revenue Code	278
Min. Negotiated Rate	$119.20
Max. Negotiated Rate	$2,098.55
Rate for Payer: Aetna Commercial	$1,594.90
Rate for Payer: Aetna Medicare Advantage	$1,259.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,070.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,070.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$839.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,070.26
Rate for Payer: Cigna Commercial	$2,098.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,015.70
Rate for Payer: Qualcare PPO/HMO/WC	$629.57
Rate for Payer: UnitedHealthcare Community & State	$132.63
Rate for Payer: Wellpoint Medicaid Managed Care	$119.20

LINER HUMERAL 39 +3

Facility

$5,075.00

Hospital Charge Code	270672405
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 39 +3

Facility

$5,075.00

Hospital Charge Code	270672405
Hospital Revenue Code	278
Min. Negotiated Rate	$144.13
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$160.37
Rate for Payer: Wellpoint Medicaid Managed Care	$144.13

LINER HUMERAL 39 +3C

Facility

$5,075.00

Hospital Charge Code	270672406
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 39 +3C

Facility

$5,075.00

Hospital Charge Code	270672406
Hospital Revenue Code	278
Min. Negotiated Rate	$144.13
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$160.37
Rate for Payer: Wellpoint Medicaid Managed Care	$144.13

LINER HUMERAL 39 +6

Facility

$5,075.00

Hospital Charge Code	270672407
Hospital Revenue Code	278
Min. Negotiated Rate	$144.13
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$160.37
Rate for Payer: Wellpoint Medicaid Managed Care	$144.13

LINER HUMERAL 39 +6

Facility

$5,075.00

Hospital Charge Code	270672407
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 39 +6C

Facility

$5,075.00

Hospital Charge Code	270672408
Hospital Revenue Code	278
Min. Negotiated Rate	$144.13
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$160.37
Rate for Payer: Wellpoint Medicaid Managed Care	$144.13

LINER HUMERAL 39 +6C

Facility

$5,075.00

Hospital Charge Code	270672408
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 42 +3

Facility

$5,075.00

Hospital Charge Code	270672401
Hospital Revenue Code	278
Min. Negotiated Rate	$144.13
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$160.37
Rate for Payer: Wellpoint Medicaid Managed Care	$144.13

LINER HUMERAL 42 +3

Facility

$5,075.00

Hospital Charge Code	270672401
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 42 +3C

Facility

$5,075.00

Hospital Charge Code	270672402
Hospital Revenue Code	278
Min. Negotiated Rate	$144.13
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$160.37
Rate for Payer: Wellpoint Medicaid Managed Care	$144.13

LINER HUMERAL 42 +3C

Facility

$5,075.00

Hospital Charge Code	270672402
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 42 +6

Facility

$5,075.00

Hospital Charge Code	270672403
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

Know your out-of-pocket cost for care.

All Charges