Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ACETABULAR LINER +4OFF-28/52

Facility

$6,660.00

Hospital Charge Code	270668943
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-28/54

Facility

$6,660.00

Hospital Charge Code	270668944
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-28/54

Facility

$6,660.00

Hospital Charge Code	270668944
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER +4OFF-28/56

Facility

$6,660.00

Hospital Charge Code	270668945
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-28/56

Facility

$6,660.00

Hospital Charge Code	270668945
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER +4OFF-32/48

Facility

$6,660.00

Hospital Charge Code	270668949
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-32/48

Facility

$6,660.00

Hospital Charge Code	270668949
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER +4OFF-32/50

Facility

$6,660.00

Hospital Charge Code	270668950
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER +4OFF-32/50

Facility

$6,660.00

Hospital Charge Code	270668950
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-32/52

Facility

$6,660.00

Hospital Charge Code	270668951
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-32/52

Facility

$6,660.00

Hospital Charge Code	270668951
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER +4OFF-32/54

Facility

$6,660.00

Hospital Charge Code	270668952
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER +4OFF-32/54

Facility

$6,660.00

Hospital Charge Code	270668952
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-32/56

Facility

$6,660.00

Hospital Charge Code	270668953
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER +4OFF-32/56

Facility

$6,660.00

Hospital Charge Code	270668953
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-36/52

Facility

$6,660.00

Hospital Charge Code	270668958
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER +4OFF-36/52

Facility

$6,660.00

Hospital Charge Code	270668958
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-36/54

Facility

$6,660.00

Hospital Charge Code	270668959
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER +4OFF-36/54

Facility

$6,660.00

Hospital Charge Code	270668959
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-36/56

Facility

$6,660.00

Hospital Charge Code	270668960
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER +4OFF-36/56

Facility

$6,660.00

Hospital Charge Code	270668960
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER HIGH-28/44

Facility

$6,660.00

Hospital Charge Code	270668964
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER HIGH-28/44

Facility

$6,660.00

Hospital Charge Code	270668964
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

ACETABULAR LINER HIGH 28/46

Facility

$6,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270668965
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,330.00
Rate for Payer: Aetna Commercial	$2,530.80
Rate for Payer: Aetna Medicare Advantage	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,698.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,698.30
Rate for Payer: Cigna Commercial	$3,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00
Rate for Payer: UnitedHealthcare Community & State	$210.46
Rate for Payer: Wellpoint Medicaid Managed Care	$189.14

ACETABULAR LINER HIGH 28/46

Facility

$6,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270668965
Hospital Revenue Code	278
Min. Negotiated Rate	$999.00
Max. Negotiated Rate	$1,611.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,611.72
Rate for Payer: Qualcare PPO/HMO/WC	$999.00

Know your out-of-pocket cost for care.

All Charges