Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA INSTRUMENT SET

Facility

$500.00

Hospital Charge Code	270687769
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

PATELLA INSTRUMENT SET

Facility

$500.00

Hospital Charge Code	270687769
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

PATELLA LAT VAL 2.4 /2.7 SS

Facility

$10,836.80

Service Code	HCPCS C1713
Hospital Charge Code	270694000
Hospital Revenue Code	278
Min. Negotiated Rate	$307.77
Max. Negotiated Rate	$5,418.40
Rate for Payer: Aetna Commercial	$4,117.98
Rate for Payer: Aetna Medicare Advantage	$3,251.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,763.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,763.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,167.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,763.38
Rate for Payer: Cigna Commercial	$5,418.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,622.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,625.52
Rate for Payer: UnitedHealthcare Community & State	$342.44
Rate for Payer: Wellpoint Medicaid Managed Care	$307.77

PATELLA LAT VAL 2.4 /2.7 SS

Facility

$10,836.80

Service Code	HCPCS C1713
Hospital Charge Code	270694000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,625.52
Max. Negotiated Rate	$2,622.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,167.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,622.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,625.52

PATELLA LIGAMENT 10MM PRECUT

Facility

$17,777.50

Hospital Charge Code	270670447
Hospital Revenue Code	278
Min. Negotiated Rate	$2,666.62
Max. Negotiated Rate	$4,302.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,555.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,302.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,666.62

PATELLA LIGAMENT 10MM PRECUT

Facility

$17,777.50

Hospital Charge Code	270670447
Hospital Revenue Code	278
Min. Negotiated Rate	$504.88
Max. Negotiated Rate	$8,888.75
Rate for Payer: Aetna Commercial	$6,755.45
Rate for Payer: Aetna Medicare Advantage	$5,333.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,533.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,533.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,533.26
Rate for Payer: Cigna Commercial	$8,888.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,302.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,666.62
Rate for Payer: UnitedHealthcare Community & State	$561.77
Rate for Payer: Wellpoint Medicaid Managed Care	$504.88

PATELLA MEDIALIZED DOME 29 MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685561
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PATELLA MEDIALIZED DOME 29 MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685561
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

PATELLA MEDIALIZED DOME 32MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685507
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PATELLA MEDIALIZED DOME 32MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685507
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

PATELLA NEXGEN POROUS TM 10X

Facility

$9,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270698908
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.00
Max. Negotiated Rate	$2,265.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,265.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,404.00

PATELLA NEXGEN POROUS TM 10X

Facility

$9,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270698908
Hospital Revenue Code	278
Min. Negotiated Rate	$265.82
Max. Negotiated Rate	$4,680.00
Rate for Payer: Aetna Commercial	$3,556.80
Rate for Payer: Aetna Medicare Advantage	$2,808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,386.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,386.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,386.80
Rate for Payer: Cigna Commercial	$4,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,265.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,404.00
Rate for Payer: UnitedHealthcare Community & State	$295.78
Rate for Payer: Wellpoint Medicaid Managed Care	$265.82

PATELLA ON SET 3 PEGS 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676679
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 ON SET 3 PEGS 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676679
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 PEG 3 CEMENT 41MM DIA

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270670648
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 PEG 3 CEMENT 41MM DIA

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270670648
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, POLY 29MM NEXGEN A

Facility

$2,300.00

Hospital Charge Code	270665752
Hospital Revenue Code	278
Min. Negotiated Rate	$65.32
Max. Negotiated Rate	$1,150.00
Rate for Payer: Aetna Commercial	$874.00
Rate for Payer: Aetna Medicare Advantage	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.50
Rate for Payer: Cigna Commercial	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00
Rate for Payer: UnitedHealthcare Community & State	$72.68
Rate for Payer: Wellpoint Medicaid Managed Care	$65.32

PATELLA, POLY 29MM NEXGEN A

Facility

$2,300.00

Hospital Charge Code	270665752
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

PATELLA PRIMARY REGENEREX 3PEG

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270655089
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

PATELLA PRIMARY REGENEREX 3PEG

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270655089
Hospital Revenue Code	278
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$55.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.70

PATELLA PSN ALL POLY 32 MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686544
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 PSN ALL POLY 32 MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686544
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 PSN ALL POLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689503
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 PSN ALL POLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689503
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

PATELLAR COMPONENT OVAL SZ

Facility

$2,750.00

Hospital Charge Code	270667534
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

Know your out-of-pocket cost for care.

All Charges