Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA STD 37x10MM 3-PEG

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270640765
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 STD ALL POLY 8.0X29MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696278
Hospital Revenue Code	278
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) NJ Health	$100.00
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	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

PATELLA STD ALL POLY 8.0X29MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696278
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

PATELLA SYMMERIC S31 9 MM

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270691025
Hospital Revenue Code	278
Min. Negotiated Rate	$72.43
Max. Negotiated Rate	$1,275.25
Rate for Payer: Aetna Commercial	$969.19
Rate for Payer: Aetna Medicare Advantage	$765.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.38
Rate for Payer: Cigna Commercial	$1,275.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.22
Rate for Payer: Qualcare PPO/HMO/WC	$382.57
Rate for Payer: UnitedHealthcare Community & State	$80.60
Rate for Payer: Wellpoint Medicaid Managed Care	$72.43

PATELLA SYMMERIC S31 9 MM

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270691025
Hospital Revenue Code	278
Min. Negotiated Rate	$382.57
Max. Negotiated Rate	$617.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.22
Rate for Payer: Qualcare PPO/HMO/WC	$382.57

PATELLA SYMMETRIC X3 36MMx10MM

Facility

$2,569.35

Service Code	HCPCS C1776
Hospital Charge Code	270681039
Hospital Revenue Code	278
Min. Negotiated Rate	$385.40
Max. Negotiated Rate	$621.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.78
Rate for Payer: Qualcare PPO/HMO/WC	$385.40

PATELLA SYMMETRIC X3 36MMx10MM

Facility

$2,569.35

Service Code	HCPCS C1776
Hospital Charge Code	270681039
Hospital Revenue Code	278
Min. Negotiated Rate	$72.97
Max. Negotiated Rate	$1,284.67
Rate for Payer: Aetna Commercial	$976.35
Rate for Payer: Aetna Medicare Advantage	$770.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.18
Rate for Payer: Cigna Commercial	$1,284.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.78
Rate for Payer: Qualcare PPO/HMO/WC	$385.40
Rate for Payer: UnitedHealthcare Community & State	$81.19
Rate for Payer: Wellpoint Medicaid Managed Care	$72.97

PATELLA SYSTEM 11MM

Facility

$825.00

Service Code	HCPCS C1776
Hospital Charge Code	270692772
Hospital Revenue Code	278
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Community & State	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$23.43

PATELLA SYSTEM 11MM

Facility

$825.00

Service Code	HCPCS C1776
Hospital Charge Code	270692772
Hospital Revenue Code	278
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$199.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

PATELLA SZ 38 MM 9 MM

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270692718
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 SZ 38 MM 9 MM

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270692718
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 TENDON GRAFT(REGEN. TE

Facility

$7,578.00

Hospital Charge Code	270335414
Hospital Revenue Code	278
Min. Negotiated Rate	$1,136.70
Max. Negotiated Rate	$1,833.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,515.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,833.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,136.70

PATELLA TENDON GRAFT(REGEN. TE

Facility

$7,578.00

Hospital Charge Code	270335414
Hospital Revenue Code	278
Min. Negotiated Rate	$215.22
Max. Negotiated Rate	$3,789.00
Rate for Payer: Aetna Commercial	$2,879.64
Rate for Payer: Aetna Medicare Advantage	$2,273.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,932.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,932.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,515.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,932.39
Rate for Payer: Cigna Commercial	$3,789.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,833.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,136.70
Rate for Payer: UnitedHealthcare Community & State	$239.46
Rate for Payer: Wellpoint Medicaid Managed Care	$215.22

PATELLA TM STD NEXGEN 10X35MM

Facility

$9,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270699475
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 TM STD NEXGEN 10X35MM

Facility

$9,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270699475
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 TRIATHALON SYM 9x31MM

Facility

$3,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270672929
Hospital Revenue Code	278
Min. Negotiated Rate	$109.34
Max. Negotiated Rate	$1,925.00
Rate for Payer: Aetna Commercial	$1,463.00
Rate for Payer: Aetna Medicare Advantage	$1,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$981.75
Rate for Payer: Cigna Commercial	$1,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: Qualcare PPO/HMO/WC	$577.50
Rate for Payer: UnitedHealthcare Community & State	$121.66
Rate for Payer: Wellpoint Medicaid Managed Care	$109.34

PATELLA TRIATHALON SYM 9x31MM

Facility

$3,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270672929
Hospital Revenue Code	278
Min. Negotiated Rate	$577.50
Max. Negotiated Rate	$931.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: Qualcare PPO/HMO/WC	$577.50

PATELLA TRIATHLON X 3

Facility

$2,708.80

Service Code	HCPCS C1776
Hospital Charge Code	270691407
Hospital Revenue Code	278
Min. Negotiated Rate	$406.32
Max. Negotiated Rate	$655.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$541.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$655.53
Rate for Payer: Qualcare PPO/HMO/WC	$406.32

PATELLA TRIATHLON X 3

Facility

$2,708.80

Service Code	HCPCS C1776
Hospital Charge Code	270691407
Hospital Revenue Code	278
Min. Negotiated Rate	$76.93
Max. Negotiated Rate	$1,354.40
Rate for Payer: Aetna Commercial	$1,029.34
Rate for Payer: Aetna Medicare Advantage	$812.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$690.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$690.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$541.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$690.74
Rate for Payer: Cigna Commercial	$1,354.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$655.53
Rate for Payer: Qualcare PPO/HMO/WC	$406.32
Rate for Payer: UnitedHealthcare Community & State	$85.60
Rate for Payer: Wellpoint Medicaid Managed Care	$76.93

PATELLA TRITHLON X3 S 29MM 8MM

Facility

$2,569.35

Service Code	HCPCS C1776
Hospital Charge Code	270682132
Hospital Revenue Code	278
Min. Negotiated Rate	$72.97
Max. Negotiated Rate	$1,284.67
Rate for Payer: Aetna Commercial	$976.35
Rate for Payer: Aetna Medicare Advantage	$770.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.18
Rate for Payer: Cigna Commercial	$1,284.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.78
Rate for Payer: Qualcare PPO/HMO/WC	$385.40
Rate for Payer: UnitedHealthcare Community & State	$81.19
Rate for Payer: Wellpoint Medicaid Managed Care	$72.97

PATELLA TRITHLON X3 S 29MM 8MM

Facility

$2,569.35

Service Code	HCPCS C1776
Hospital Charge Code	270682132
Hospital Revenue Code	278
Min. Negotiated Rate	$385.40
Max. Negotiated Rate	$621.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.78
Rate for Payer: Qualcare PPO/HMO/WC	$385.40

PATELLA VANGRD STD 28MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692926
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 VANGRD STD 28MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692926
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 X3

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270677998
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

PATELLA X3

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270677998
Hospital Revenue Code	278
Min. Negotiated Rate	$159.31
Max. Negotiated Rate	$2,804.75
Rate for Payer: Aetna Commercial	$2,131.61
Rate for Payer: Aetna Medicare Advantage	$1,682.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,430.42
Rate for Payer: Cigna Commercial	$2,804.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42
Rate for Payer: UnitedHealthcare Community & State	$177.26
Rate for Payer: Wellpoint Medicaid Managed Care	$159.31

Know your out-of-pocket cost for care.

All Charges