Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ONLAY TIBIAL INSERT SZ 3 10MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668790
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 3 12MM

Facility

$3,935.00

Hospital Charge Code	270668791
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 3 12MM

Facility

$3,935.00

Hospital Charge Code	270668791
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 3 8MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668788
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 3 8MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668788
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 3 9MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668789
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 3 9MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668789
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 4 10MM

Facility

$3,935.00

Hospital Charge Code	270668793
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 4 10MM

Facility

$3,935.00

Hospital Charge Code	270668793
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 4 12MM

Facility

$3,935.00

Hospital Charge Code	270668794
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 4 12MM

Facility

$3,935.00

Hospital Charge Code	270668794
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 4 8MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668486
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 4 8MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668486
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 4 9MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668792
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 4 9MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668792
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 5 10MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668797
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 5 10MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668797
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 5 8MM

Facility

$3,935.00

Hospital Charge Code	270668495
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 5 8MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668795
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 5 8MM

Facility

$3,935.00

Service Code	HCPCS C1776
Hospital Charge Code	270668795
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 5 8MM

Facility

$3,935.00

Hospital Charge Code	270668495
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 5 9MM

Facility

$3,935.00

Hospital Charge Code	270668796
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 5 9MM

Facility

$3,935.00

Hospital Charge Code	270668796
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 6 10MM

Facility

$3,935.00

Hospital Charge Code	270668801
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$124.35
Rate for Payer: Wellpoint Medicaid Managed Care	$111.75

ONLAY TIBIAL INSERT SZ 6 10MM

Facility

$3,935.00

Hospital Charge Code	270668801
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

Know your out-of-pocket cost for care.

All Charges