Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$138.45
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$154.05
Rate for Payer: Wellpoint Medicaid Managed Care	$138.45

LINER STERRAD 10 X 17 TRAY

Facility

$10.50

Hospital Charge Code	270657523
Hospital Revenue Code	270
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

LINER STERRAD 10 X 17 TRAY

Facility

$10.50

Hospital Charge Code	270657523
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Commercial	$3.99
Rate for Payer: Aetna Medicare Advantage	$3.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.68
Rate for Payer: Cigna Commercial	$5.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.10
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

LINER SUCTION 1000 CC

Facility

$7.00

Hospital Charge Code	270301241
Hospital Revenue Code	270
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LINER SUCTION 1000 CC

Facility

$7.00

Hospital Charge Code	270301241
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

LINER SUCTION 1500cc 65651515

Facility

$5.88

Hospital Charge Code	270301242
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

LINER SUCTION 1500cc 65651515

Facility

$5.88

Hospital Charge Code	270301242
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare Advantage	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.50
Rate for Payer: Cigna Commercial	$2.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.53
Rate for Payer: Oxford Commercial	$1.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$1.18
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

LINER TIBIA SZ11 10MM TK EMPOW

Facility

$5,775.00

Service Code	HCPCS C1776
Hospital Charge Code	270692717
Hospital Revenue Code	278
Min. Negotiated Rate	$164.01
Max. Negotiated Rate	$2,887.50
Rate for Payer: Aetna Commercial	$2,194.50
Rate for Payer: Aetna Medicare Advantage	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.62
Rate for Payer: Cigna Commercial	$2,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.55
Rate for Payer: Qualcare PPO/HMO/WC	$866.25
Rate for Payer: UnitedHealthcare Community & State	$182.49
Rate for Payer: Wellpoint Medicaid Managed Care	$164.01

LINER TIBIA SZ11 10MM TK EMPOW

Facility

$5,775.00

Service Code	HCPCS C1776
Hospital Charge Code	270692717
Hospital Revenue Code	278
Min. Negotiated Rate	$866.25
Max. Negotiated Rate	$1,397.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.55
Rate for Payer: Qualcare PPO/HMO/WC	$866.25

LINER TIB INSERT SZ4 12MM LT

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

LINER TIB INSERT SZ4 12MM LT

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697440
Hospital Revenue Code	278
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$268.60
Rate for Payer: Wellpoint Medicaid Managed Care	$241.40

LINER VERSAFITCUP CC TRIO FLAT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681267
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 VERSAFITCUP CC TRIO FLAT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681267
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 VERSAFIT CUP HC 52/28

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270682959
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 VERSAFIT CUP HC 52/28

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270682959
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 VIVACET-E BRNG 28X46MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693416
Hospital Revenue Code	278
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

LINER VIVACET-E BRNG 28X46MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693416
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

LINEZOLID 2MG/ML (600/300) NS

Facility

$1,255.85

Service Code	NDC 409488301
Hospital Charge Code	606390163
Hospital Revenue Code	250
Min. Negotiated Rate	$35.67
Max. Negotiated Rate	$627.92
Rate for Payer: Aetna Commercial	$477.22
Rate for Payer: Aetna Medicare Advantage	$376.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.24
Rate for Payer: Cigna Commercial	$627.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.52
Rate for Payer: Oxford Commercial	$251.17
Rate for Payer: Qualcare PPO/HMO/WC	$188.38
Rate for Payer: UnitedHealthcare Commercial	$251.17
Rate for Payer: UnitedHealthcare Community & State	$39.68
Rate for Payer: Wellpoint Medicaid Managed Care	$35.67

LINEZOLID 2MG/ML (600/300) NS

Facility

$1,255.85

Service Code	NDC 409488301
Hospital Charge Code	606390163
Hospital Revenue Code	250
Min. Negotiated Rate	$188.38
Max. Negotiated Rate	$188.38
Rate for Payer: Qualcare PPO/HMO/WC	$188.38

LINEZOLID 600 MG/ 300ML

Facility

$1,255.85

Service Code	HCPCS J2020
Hospital Charge Code	60629093
Hospital Revenue Code	636
Min. Negotiated Rate	$188.38
Max. Negotiated Rate	$303.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.92
Rate for Payer: Qualcare PPO/HMO/WC	$188.38

LINEZOLID 600 MG/ 300ML

Facility

$1,255.85

Service Code	HCPCS J2020
Hospital Charge Code	60629093
Hospital Revenue Code	636
Min. Negotiated Rate	$35.67
Max. Negotiated Rate	$627.92
Rate for Payer: Aetna Commercial	$477.22
Rate for Payer: Aetna Medicare Advantage	$376.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.24
Rate for Payer: Cigna Commercial	$627.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.92
Rate for Payer: Qualcare PPO/HMO/WC	$188.38
Rate for Payer: UnitedHealthcare Community & State	$39.68
Rate for Payer: Wellpoint Medicaid Managed Care	$35.67

LINEZOLID 600 MG TAB

Facility

$1,220.81

Service Code	NDC 9513502
Hospital Charge Code	60629115
Hospital Revenue Code	250
Min. Negotiated Rate	$34.67
Max. Negotiated Rate	$610.40
Rate for Payer: Aetna Commercial	$463.91
Rate for Payer: Aetna Medicare Advantage	$366.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.31
Rate for Payer: Cigna Commercial	$610.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$317.41
Rate for Payer: Oxford Commercial	$244.16
Rate for Payer: Qualcare PPO/HMO/WC	$183.12
Rate for Payer: UnitedHealthcare Commercial	$244.16
Rate for Payer: UnitedHealthcare Community & State	$38.58
Rate for Payer: Wellpoint Medicaid Managed Care	$34.67

LINEZOLID 600 MG TAB

Facility

$1,220.81

Service Code	NDC 9513502
Hospital Charge Code	60629115
Hospital Revenue Code	250
Min. Negotiated Rate	$183.12
Max. Negotiated Rate	$183.12
Rate for Payer: Qualcare PPO/HMO/WC	$183.12

LINQ SYSTEM INCL DEVICE/MONITR

Facility

$26,475.00

Hospital Charge Code	270677215
Hospital Revenue Code	278
Min. Negotiated Rate	$751.89
Max. Negotiated Rate	$13,237.50
Rate for Payer: Aetna Commercial	$10,060.50
Rate for Payer: Aetna Medicare Advantage	$7,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,751.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,751.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,751.12
Rate for Payer: Cigna Commercial	$13,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,406.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,971.25
Rate for Payer: UnitedHealthcare Community & State	$836.61
Rate for Payer: Wellpoint Medicaid Managed Care	$751.89

LINQ SYSTEM INCL DEVICE/MONITR

Facility

$26,475.00

Hospital Charge Code	270677215
Hospital Revenue Code	278
Min. Negotiated Rate	$3,971.25
Max. Negotiated Rate	$6,406.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,406.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,971.25

Know your out-of-pocket cost for care.

All Charges