Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CUP BIPOLAR 28X50 11-165224

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270606324
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

CUP BIPOLAR 28x52 LOC 11165228

Facility

$5,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270616770
Hospital Revenue Code	278
Min. Negotiated Rate	$797.25
Max. Negotiated Rate	$1,286.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,063.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,286.23
Rate for Payer: Qualcare PPO/HMO/WC	$797.25

CUP BIPOLAR 28x52 LOC 11165228

Facility

$5,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270616770
Hospital Revenue Code	278
Min. Negotiated Rate	$150.95
Max. Negotiated Rate	$2,657.50
Rate for Payer: Aetna Commercial	$2,019.70
Rate for Payer: Aetna Medicare Advantage	$1,594.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,355.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,355.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,063.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,355.33
Rate for Payer: Cigna Commercial	$2,657.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,286.23
Rate for Payer: Qualcare PPO/HMO/WC	$797.25
Rate for Payer: UnitedHealthcare Community & State	$167.95
Rate for Payer: Wellpoint Medicaid Managed Care	$150.95

CUP BI-POLAR RINGLOC 28x54MM

Facility

$5,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270611025
Hospital Revenue Code	278
Min. Negotiated Rate	$150.95
Max. Negotiated Rate	$2,657.50
Rate for Payer: Aetna Commercial	$2,019.70
Rate for Payer: Aetna Medicare Advantage	$1,594.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,355.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,355.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,063.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,355.33
Rate for Payer: Cigna Commercial	$2,657.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,286.23
Rate for Payer: Qualcare PPO/HMO/WC	$797.25
Rate for Payer: UnitedHealthcare Community & State	$167.95
Rate for Payer: Wellpoint Medicaid Managed Care	$150.95

CUP BI-POLAR RINGLOC 28x54MM

Facility

$5,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270611025
Hospital Revenue Code	278
Min. Negotiated Rate	$797.25
Max. Negotiated Rate	$1,286.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,063.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,286.23
Rate for Payer: Qualcare PPO/HMO/WC	$797.25

CUP BMT BIPOL 11-165214

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270608730
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CUP BMT BIPOL 11-165214

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270608730
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

CUP BMT BIPOL 41MM 11-165206

Facility

$5,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270608494
Hospital Revenue Code	278
Min. Negotiated Rate	$797.25
Max. Negotiated Rate	$1,286.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,063.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,286.23
Rate for Payer: Qualcare PPO/HMO/WC	$797.25

CUP BMT BIPOL 41MM 11-165206

Facility

$5,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270608494
Hospital Revenue Code	278
Min. Negotiated Rate	$150.95
Max. Negotiated Rate	$2,657.50
Rate for Payer: Aetna Commercial	$2,019.70
Rate for Payer: Aetna Medicare Advantage	$1,594.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,355.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,355.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,063.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,355.33
Rate for Payer: Cigna Commercial	$2,657.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,286.23
Rate for Payer: Qualcare PPO/HMO/WC	$797.25
Rate for Payer: UnitedHealthcare Community & State	$167.95
Rate for Payer: Wellpoint Medicaid Managed Care	$150.95

CUP BMT BIPOL 42MM 11-165208

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270608162
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

CUP BMT BIPOL 42MM 11-165208

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270608162
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

CUP BMT BIPOL 46MM 11-165216

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270607277
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CUP BMT BIPOL 46MM 11-165216

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270607277
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

CUP BMT BIPOL 48MM 11-165220

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270617430
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

CUP BMT BIPOL 48MM 11-165220

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270617430
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

CUP BMT BIPOL 53MM 11-165230

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270625411
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CUP BMT BIPOL 53MM 11-165230

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270625411
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

CUP DELTA XTEND HUM PE STD38/6

Facility

$4,800.00

Service Code	HCPCS C1776
Hospital Charge Code	270686440
Hospital Revenue Code	278
Min. Negotiated Rate	$136.32
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,824.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00
Rate for Payer: UnitedHealthcare Community & State	$151.68
Rate for Payer: Wellpoint Medicaid Managed Care	$136.32

CUP DELTA XTEND HUM PE STD38/6

Facility

$4,800.00

Service Code	HCPCS C1776
Hospital Charge Code	270686440
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

CUP HUMERAL 36X4MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270671576
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

CUP HUMERAL 36X4MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270671576
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

CUP HUMERAL BEAR RET 36MM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696537
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

CUP HUMERAL BEAR RET 36MM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696537
Hospital Revenue Code	278
Min. Negotiated Rate	$326.60
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$363.40
Rate for Payer: Wellpoint Medicaid Managed Care	$326.60

CUP MODULAR 10 DEGREE LINER

Facility

$4,455.00

Hospital Charge Code	270663511
Hospital Revenue Code	278
Min. Negotiated Rate	$126.52
Max. Negotiated Rate	$2,227.50
Rate for Payer: Aetna Commercial	$1,692.90
Rate for Payer: Aetna Medicare Advantage	$1,336.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,136.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,136.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,136.03
Rate for Payer: Cigna Commercial	$2,227.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.11
Rate for Payer: Qualcare PPO/HMO/WC	$668.25
Rate for Payer: UnitedHealthcare Community & State	$140.78
Rate for Payer: Wellpoint Medicaid Managed Care	$126.52

CUP MODULAR 10 DEGREE LINER

Facility

$4,455.00

Hospital Charge Code	270663511
Hospital Revenue Code	278
Min. Negotiated Rate	$668.25
Max. Negotiated Rate	$1,078.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$891.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.11
Rate for Payer: Qualcare PPO/HMO/WC	$668.25

Know your out-of-pocket cost for care.

All Charges