Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LINER POLY STANDARD 0 PLUS

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689177
Hospital Revenue Code	278
Min. Negotiated Rate	$180.63
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$2,416.89
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04
Rate for Payer: UnitedHealthcare Community & State	$200.98
Rate for Payer: Wellpoint Medicaid Managed Care	$180.63

LINER POLY STANDARD 0 PLUS

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689177
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

LINER POLY STANDARD +3

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689633
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

LINER POLY STANDARD +3

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689633
Hospital Revenue Code	278
Min. Negotiated Rate	$180.63
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$2,416.89
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04
Rate for Payer: UnitedHealthcare Community & State	$200.98
Rate for Payer: Wellpoint Medicaid Managed Care	$180.63

LINER PRIME ECLASS LIPPED 36MM

Facility

$3,415.00

Service Code	HCPCS C1776
Hospital Charge Code	270697654
Hospital Revenue Code	278
Min. Negotiated Rate	$512.25
Max. Negotiated Rate	$826.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$683.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.43
Rate for Payer: Qualcare PPO/HMO/WC	$512.25

LINER PRIME ECLASS LIPPED 36MM

Facility

$3,415.00

Service Code	HCPCS C1776
Hospital Charge Code	270697654
Hospital Revenue Code	278
Min. Negotiated Rate	$96.99
Max. Negotiated Rate	$1,707.50
Rate for Payer: Aetna Commercial	$1,297.70
Rate for Payer: Aetna Medicare Advantage	$1,024.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$870.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$870.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$870.83
Rate for Payer: Cigna Commercial	$1,707.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.43
Rate for Payer: Qualcare PPO/HMO/WC	$512.25
Rate for Payer: UnitedHealthcare Community & State	$107.91
Rate for Payer: Wellpoint Medicaid Managed Care	$96.99

LINER PSN POLY PLY 38 MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690743
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

LINER PSN POLY PLY 38 MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690743
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

LINER RINGLOC ACETEBULAR 32MM

Facility

$5,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270637438
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 RINGLOC ACETEBULAR 32MM

Facility

$5,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270637438
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

LINER RSS HXL STD 9S

Facility

$6,532.75

Service Code	HCPCS C1776
Hospital Charge Code	270691443
Hospital Revenue Code	278
Min. Negotiated Rate	$185.53
Max. Negotiated Rate	$3,266.38
Rate for Payer: Aetna Commercial	$2,482.45
Rate for Payer: Aetna Medicare Advantage	$1,959.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,665.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,665.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,665.85
Rate for Payer: Cigna Commercial	$3,266.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.93
Rate for Payer: Qualcare PPO/HMO/WC	$979.91
Rate for Payer: UnitedHealthcare Community & State	$206.43
Rate for Payer: Wellpoint Medicaid Managed Care	$185.53

LINER RSS HXL STD 9S

Facility

$6,532.75

Service Code	HCPCS C1776
Hospital Charge Code	270691443
Hospital Revenue Code	278
Min. Negotiated Rate	$979.91
Max. Negotiated Rate	$1,580.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,306.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.93
Rate for Payer: Qualcare PPO/HMO/WC	$979.91

LINER RSS STD 6S PLUS

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270691072
Hospital Revenue Code	278
Min. Negotiated Rate	$964.30
Max. Negotiated Rate	$1,555.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: Qualcare PPO/HMO/WC	$964.30

LINER RSS STD 6S PLUS

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270691072
Hospital Revenue Code	278
Min. Negotiated Rate	$182.58
Max. Negotiated Rate	$3,214.35
Rate for Payer: Aetna Commercial	$2,442.91
Rate for Payer: Aetna Medicare Advantage	$1,928.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,639.32
Rate for Payer: Cigna Commercial	$3,214.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: Qualcare PPO/HMO/WC	$964.30
Rate for Payer: UnitedHealthcare Community & State	$203.15
Rate for Payer: Wellpoint Medicaid Managed Care	$182.58

LINER SIZE 3

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688878
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

LINER SIZE 3

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688878
Hospital Revenue Code	278
Min. Negotiated Rate	$180.63
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$2,416.89
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04
Rate for Payer: UnitedHealthcare Community & State	$200.98
Rate for Payer: Wellpoint Medicaid Managed Care	$180.63

LINER SIZE 9

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689175
Hospital Revenue Code	278
Min. Negotiated Rate	$180.63
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$2,416.89
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04
Rate for Payer: UnitedHealthcare Community & State	$200.98
Rate for Payer: Wellpoint Medicaid Managed Care	$180.63

LINER SIZE 9

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689175
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

LINER STANDARD +3S RSS

Facility

$6,423.70

Service Code	HCPCS C1776
Hospital Charge Code	270690995
Hospital Revenue Code	278
Min. Negotiated Rate	$963.55
Max. Negotiated Rate	$1,554.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.54
Rate for Payer: Qualcare PPO/HMO/WC	$963.55

LINER STANDARD +3S RSS

Facility

$6,423.70

Service Code	HCPCS C1776
Hospital Charge Code	270690995
Hospital Revenue Code	278
Min. Negotiated Rate	$182.43
Max. Negotiated Rate	$3,211.85
Rate for Payer: Aetna Commercial	$2,441.01
Rate for Payer: Aetna Medicare Advantage	$1,927.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,638.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,638.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,638.04
Rate for Payer: Cigna Commercial	$3,211.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.54
Rate for Payer: Qualcare PPO/HMO/WC	$963.55
Rate for Payer: UnitedHealthcare Community & State	$202.99
Rate for Payer: Wellpoint Medicaid Managed Care	$182.43

LINER STANDARD 9

Facility

$5,279.20

Service Code	HCPCS C1776
Hospital Charge Code	270689618
Hospital Revenue Code	278
Min. Negotiated Rate	$791.88
Max. Negotiated Rate	$1,277.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,055.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.57
Rate for Payer: Qualcare PPO/HMO/WC	$791.88

LINER STANDARD 9

Facility

$5,279.20

Service Code	HCPCS C1776
Hospital Charge Code	270689618
Hospital Revenue Code	278
Min. Negotiated Rate	$149.93
Max. Negotiated Rate	$2,639.60
Rate for Payer: Aetna Commercial	$2,006.10
Rate for Payer: Aetna Medicare Advantage	$1,583.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,055.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.20
Rate for Payer: Cigna Commercial	$2,639.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.57
Rate for Payer: Qualcare PPO/HMO/WC	$791.88
Rate for Payer: UnitedHealthcare Community & State	$166.82
Rate for Payer: Wellpoint Medicaid Managed Care	$149.93

LINER STD FACE 36x23mm

Facility

$14,045.00

Hospital Charge Code	270675922
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.75
Max. Negotiated Rate	$3,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,809.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,398.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,106.75

LINER STD FACE 36x23mm

Facility

$14,045.00

Hospital Charge Code	270675922
Hospital Revenue Code	278
Min. Negotiated Rate	$398.88
Max. Negotiated Rate	$7,022.50
Rate for Payer: Aetna Commercial	$5,337.10
Rate for Payer: Aetna Medicare Advantage	$4,213.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,809.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,581.47
Rate for Payer: Cigna Commercial	$7,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,398.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,106.75
Rate for Payer: UnitedHealthcare Community & State	$443.82
Rate for Payer: Wellpoint Medicaid Managed Care	$398.88

LINER STD F/METAL BACK GLENOID

Facility

$4,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270675411
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

Know your out-of-pocket cost for care.

All Charges