Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA RESURFACE RD DOME 41MM

Facility

$3,770.00

Hospital Charge Code	270668852
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$912.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: Qualcare PPO/HMO/WC	$565.50

PATELLA RESURFACE RD DOME 41MM

Facility

$3,770.00

Hospital Charge Code	270668852
Hospital Revenue Code	278
Min. Negotiated Rate	$107.07
Max. Negotiated Rate	$1,885.00
Rate for Payer: Aetna Commercial	$1,432.60
Rate for Payer: Aetna Medicare Advantage	$1,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$961.35
Rate for Payer: Cigna Commercial	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: Qualcare PPO/HMO/WC	$565.50
Rate for Payer: UnitedHealthcare Community & State	$119.13
Rate for Payer: Wellpoint Medicaid Managed Care	$107.07

PATELLA RESURFACING S2

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667708
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 RESURFACING S2

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667708
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 RESURFACING SZ1

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672251
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 RESURFACING SZ1

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672251
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 RESURFACING SZ3

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677521
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 RESURFACING SZ3

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677521
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 RESURFACING TRIAL

Facility

$326.25

Service Code	HCPCS C1776
Hospital Charge Code	270688384
Hospital Revenue Code	278
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$78.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.95
Rate for Payer: Qualcare PPO/HMO/WC	$48.94

PATELLA RESURFACING TRIAL

Facility

$326.25

Service Code	HCPCS C1776
Hospital Charge Code	270688384
Hospital Revenue Code	278
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$163.12
Rate for Payer: Aetna Commercial	$123.97
Rate for Payer: Aetna Medicare Advantage	$97.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.19
Rate for Payer: Cigna Commercial	$163.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.95
Rate for Payer: Qualcare PPO/HMO/WC	$48.94
Rate for Payer: UnitedHealthcare Community & State	$10.31
Rate for Payer: Wellpoint Medicaid Managed Care	$9.27

PATELLA RGX 3 PEG 28MM

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270677861
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 RGX 3 PEG 28MM

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270677861
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 RIM LAT 2.4/2.7

Facility

$10,836.80

Service Code	HCPCS C1776
Hospital Charge Code	270693887
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 RIM LAT 2.4/2.7

Facility

$10,836.80

Service Code	HCPCS C1776
Hospital Charge Code	270693887
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 SAIPH 38mm CEMENTED

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270680034
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 SAIPH 38mm CEMENTED

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270680034
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 SOMBRERO SZ1 7MM

Facility

$1,500.00

Hospital Charge Code	270677277
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 SOMBRERO SZ1 7MM

Facility

$1,500.00

Hospital Charge Code	270677277
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 SOMBRERO SZ 2 7MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675544
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 SOMBRERO SZ 2 7MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675544
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 SOMBRERO SZ 2 7x31MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675282
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 SOMBRERO SZ 2 7x31MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675282
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 ST ALLPOLY 38MM 9.5MM

Facility

$450.00

Service Code	HCPCS C1776
Hospital Charge Code	270694197
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

PATELLA ST ALLPOLY 38MM 9.5MM

Facility

$450.00

Service Code	HCPCS C1776
Hospital Charge Code	270694197
Hospital Revenue Code	278
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$12.78

PATELLA STD 37x10MM 3-PEG

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270640765
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

Know your out-of-pocket cost for care.

All Charges