Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA 41MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676728
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

PATELLA 41MM 10.0MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690961
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

PATELLA 41MM 10.0MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690961
Hospital Revenue Code	278
Min. Negotiated Rate	$145.69
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$162.11
Rate for Payer: Wellpoint Medicaid Managed Care	$145.69

PATELLA ADVANCE TRI-PEG 8X32MM

Facility

$0.05

Service Code	HCPCS C1776
Hospital Charge Code	270697718
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

PATELLA ADVANCE TRI-PEG 8X32MM

Facility

$0.05

Service Code	HCPCS C1776
Hospital Charge Code	270697718
Hospital Revenue Code	278
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna Commercial	$0.02
Rate for Payer: Aetna Medicare Advantage	$0.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.01
Rate for Payer: Cigna Commercial	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

PATELLA ALL POLY VE 29MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270693757
Hospital Revenue Code	278
Min. Negotiated Rate	$145.69
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$162.11
Rate for Payer: Wellpoint Medicaid Managed Care	$145.69

PATELLA ALL POLY VE 29MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270693757
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

PATELLA ASYMMETRIC 10X32

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691265
Hospital Revenue Code	278
Min. Negotiated Rate	$371.01
Max. Negotiated Rate	$598.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$494.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.56
Rate for Payer: Qualcare PPO/HMO/WC	$371.01

PATELLA ASYMMETRIC 10X32

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691265
Hospital Revenue Code	278
Min. Negotiated Rate	$70.24
Max. Negotiated Rate	$1,236.70
Rate for Payer: Aetna Commercial	$939.89
Rate for Payer: Aetna Medicare Advantage	$742.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$630.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$630.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$494.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$630.72
Rate for Payer: Cigna Commercial	$1,236.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.56
Rate for Payer: Qualcare PPO/HMO/WC	$371.01
Rate for Payer: UnitedHealthcare Community & State	$78.16
Rate for Payer: Wellpoint Medicaid Managed Care	$70.24

PATELLA ASYMMETRIC A35 MM

Facility

$2,570.60

Service Code	HCPCS C1776
Hospital Charge Code	270691403
Hospital Revenue Code	278
Min. Negotiated Rate	$385.59
Max. Negotiated Rate	$622.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.09
Rate for Payer: Qualcare PPO/HMO/WC	$385.59

PATELLA ASYMMETRIC A35 MM

Facility

$2,570.60

Service Code	HCPCS C1776
Hospital Charge Code	270691403
Hospital Revenue Code	278
Min. Negotiated Rate	$73.01
Max. Negotiated Rate	$1,285.30
Rate for Payer: Aetna Commercial	$976.83
Rate for Payer: Aetna Medicare Advantage	$771.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.50
Rate for Payer: Cigna Commercial	$1,285.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.09
Rate for Payer: Qualcare PPO/HMO/WC	$385.59
Rate for Payer: UnitedHealthcare Community & State	$81.23
Rate for Payer: Wellpoint Medicaid Managed Care	$73.01

PATELLA BUTTON 31mm 184764

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639770
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

PATELLA BUTTON 31mm 184764

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639770
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA CEMENTED 3 PEG 35MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270668547
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

PATELLA CEMENTED 3 PEG 35MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270668547
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA CEMENTED 3 PEG 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668744
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA CEMENTED 3 PEG 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668744
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

PATELLA COMPONENT

Facility

$6,705.00

Hospital Charge Code	270666806
Hospital Revenue Code	278
Min. Negotiated Rate	$190.42
Max. Negotiated Rate	$3,352.50
Rate for Payer: Aetna Commercial	$2,547.90
Rate for Payer: Aetna Medicare Advantage	$2,011.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,709.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,709.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,709.78
Rate for Payer: Cigna Commercial	$3,352.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.75
Rate for Payer: UnitedHealthcare Community & State	$211.88
Rate for Payer: Wellpoint Medicaid Managed Care	$190.42

PATELLA COMPONENT

Facility

$6,705.00

Hospital Charge Code	270666806
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.75
Max. Negotiated Rate	$1,622.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,341.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.75

PATELLA DOMED TRI SZ 35 MM

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270691777
Hospital Revenue Code	278
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$1,197.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50
Rate for Payer: UnitedHealthcare Community & State	$99.54
Rate for Payer: Wellpoint Medicaid Managed Care	$89.46

PATELLA DOMED TRI SZ 35 MM

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270691777
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678266
Hospital Revenue Code	272
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.95
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$11.30
Rate for Payer: Wellpoint Medicaid Managed Care	$10.15

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678266
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678376
Hospital Revenue Code	272
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.95
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$11.30
Rate for Payer: Wellpoint Medicaid Managed Care	$10.15

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678376
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

Know your out-of-pocket cost for care.

All Charges