Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ACETABULAR LINER HIGH-28/48

Facility

$6,660.00

Hospital Charge Code	270668966
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-28/48

Facility

$6,660.00

Hospital Charge Code	270668966
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-28/50

Facility

$6,660.00

Hospital Charge Code	270668967
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-28/50

Facility

$6,660.00

Hospital Charge Code	270668967
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 28/52

Facility

$6,660.00

Hospital Charge Code	270668968
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 28/52

Facility

$6,660.00

Hospital Charge Code	270668968
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-28/54

Facility

$6,660.00

Hospital Charge Code	270668969
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-28/54

Facility

$6,660.00

Hospital Charge Code	270668969
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-28/56

Facility

$6,660.00

Hospital Charge Code	270668970
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-28/56

Facility

$6,660.00

Hospital Charge Code	270668970
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-28/58-60

Facility

$6,660.00

Hospital Charge Code	270668971
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-28/58-60

Facility

$6,660.00

Hospital Charge Code	270668971
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-28/62-64

Facility

$6,660.00

Hospital Charge Code	270668972
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-28/62-64

Facility

$6,660.00

Hospital Charge Code	270668972
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-28/66-70

Facility

$6,660.00

Hospital Charge Code	270668973
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-28/66-70

Facility

$6,660.00

Hospital Charge Code	270668973
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-32/48

Facility

$6,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270668974
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-32/48

Facility

$6,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270668974
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-32/50

Facility

$6,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270668975
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-32/50

Facility

$6,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270668975
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-32/52

Facility

$6,660.00

Hospital Charge Code	270668976
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-32/52

Facility

$6,660.00

Hospital Charge Code	270668976
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-32/54

Facility

$6,660.00

Hospital Charge Code	270668977
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-32/54

Facility

$6,660.00

Hospital Charge Code	270668977
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-32/56

Facility

$6,660.00

Hospital Charge Code	270668978
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

Know your out-of-pocket cost for care.

All Charges