Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BIPOLAR HEAD

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688351
Hospital Revenue Code	278
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

BIPOLAR HEAD 28x44MM

Facility

$4,750.00

Hospital Charge Code	270674075
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

BIPOLAR HEAD 28x44MM

Facility

$4,750.00

Hospital Charge Code	270674075
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

BIPOLAR HEAD 41MM OD 22MM HEAD

Facility

$3,500.00

Hospital Charge Code	270676226
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 41MM OD 22MM HEAD

Facility

$3,500.00

Hospital Charge Code	270676226
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

BIPOLAR HEAD 44MM

Facility

$2,000.00

Hospital Charge Code	270675288
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

BIPOLAR HEAD 44MM

Facility

$2,000.00

Hospital Charge Code	270675288
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

BIPOLAR HEAD 44MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676159
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

BIPOLAR HEAD 44MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676159
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 45MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675313
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

BIPOLAR HEAD 45MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675313
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 47MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676219
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

BIPOLAR HEAD 47MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676219
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 49MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675841
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

BIPOLAR HEAD 49MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675841
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 50MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675416
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 50MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675416
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

BIPOLAR HEAD COMP UNIV 44X28MM

Facility

$5,833.30

Service Code	HCPCS C1776
Hospital Charge Code	270697701
Hospital Revenue Code	278
Min. Negotiated Rate	$165.67
Max. Negotiated Rate	$2,916.65
Rate for Payer: Aetna Commercial	$2,216.65
Rate for Payer: Aetna Medicare Advantage	$1,749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,487.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,487.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,487.49
Rate for Payer: Cigna Commercial	$2,916.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,411.66
Rate for Payer: Qualcare PPO/HMO/WC	$875.00
Rate for Payer: UnitedHealthcare Community & State	$184.33
Rate for Payer: Wellpoint Medicaid Managed Care	$165.67

BIPOLAR HEAD COMP UNIV 44X28MM

Facility

$5,833.30

Service Code	HCPCS C1776
Hospital Charge Code	270697701
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$1,411.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,411.66
Rate for Payer: Qualcare PPO/HMO/WC	$875.00

BI-POLAR HEAD SELF CENTERING

Facility

$6,770.00

Service Code	HCPCS C1776
Hospital Charge Code	270663840
Hospital Revenue Code	278
Min. Negotiated Rate	$192.27
Max. Negotiated Rate	$3,385.00
Rate for Payer: Aetna Commercial	$2,572.60
Rate for Payer: Aetna Medicare Advantage	$2,031.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,726.35
Rate for Payer: Cigna Commercial	$3,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50
Rate for Payer: UnitedHealthcare Community & State	$213.93
Rate for Payer: Wellpoint Medicaid Managed Care	$192.27

BI-POLAR HEAD SELF CENTERING

Facility

$6,770.00

Service Code	HCPCS C1776
Hospital Charge Code	270663840
Hospital Revenue Code	278
Min. Negotiated Rate	$1,015.50
Max. Negotiated Rate	$1,638.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50

BIPOLAR HEAD SZ 42MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675406
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

BIPOLAR HEAD SZ 42MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675406
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD SZ 44MM HEAD 2

Facility

$14,695.00

Hospital Charge Code	270667793
Hospital Revenue Code	278
Min. Negotiated Rate	$417.34
Max. Negotiated Rate	$7,347.50
Rate for Payer: Aetna Commercial	$5,584.10
Rate for Payer: Aetna Medicare Advantage	$4,408.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,747.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,747.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,939.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,747.22
Rate for Payer: Cigna Commercial	$7,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,556.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,204.25
Rate for Payer: UnitedHealthcare Community & State	$464.36
Rate for Payer: Wellpoint Medicaid Managed Care	$417.34

BIPOLAR HEAD SZ 44MM HEAD 2

Facility

$14,695.00

Hospital Charge Code	270667793
Hospital Revenue Code	278
Min. Negotiated Rate	$2,204.25
Max. Negotiated Rate	$3,556.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,939.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,556.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,204.25

Know your out-of-pocket cost for care.

All Charges