Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA X3 TRIATHLON 11X40

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691995
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 X3 TRIATHLON 11X40

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691995
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 X3 TRIATHLON A20 11MM

Facility

$9,635.00

Service Code	HCPCS C1776
Hospital Charge Code	270691992
Hospital Revenue Code	278
Min. Negotiated Rate	$273.63
Max. Negotiated Rate	$4,817.50
Rate for Payer: Aetna Commercial	$3,661.30
Rate for Payer: Aetna Medicare Advantage	$2,890.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,456.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,456.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,927.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,456.93
Rate for Payer: Cigna Commercial	$4,817.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,331.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,445.25
Rate for Payer: UnitedHealthcare Community & State	$304.47
Rate for Payer: Wellpoint Medicaid Managed Care	$273.63

PATELLA X3 TRIATHLON A20 11MM

Facility

$9,635.00

Service Code	HCPCS C1776
Hospital Charge Code	270691992
Hospital Revenue Code	278
Min. Negotiated Rate	$1,445.25
Max. Negotiated Rate	$2,331.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,927.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,331.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,445.25

PATELLOFEMORAL COMPON SZ4 LEFT

Facility

$12,580.00

Service Code	HCPCS C1776
Hospital Charge Code	270668855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL COMPON SZ4 LEFT

Facility

$12,580.00

Service Code	HCPCS C1776
Hospital Charge Code	270668855
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

PATELLOFEMORAL LEFT SZ 2

Facility

$12,580.00

Hospital Charge Code	270668853
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

PATELLOFEMORAL LEFT SZ 2

Facility

$12,580.00

Hospital Charge Code	270668853
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 3

Facility

$12,580.00

Hospital Charge Code	270668854
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 3

Facility

$12,580.00

Hospital Charge Code	270668854
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

PATELLOFEMORAL LEFT SZ 5

Facility

$12,580.00

Hospital Charge Code	270668856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 5

Facility

$12,580.00

Hospital Charge Code	270668856
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

PATELLOFEMORAL LEFT SZ 6

Facility

$12,580.00

Hospital Charge Code	270668857
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

PATELLOFEMORAL LEFT SZ 6

Facility

$12,580.00

Hospital Charge Code	270668857
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 7

Facility

$12,580.00

Hospital Charge Code	270668858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 7

Facility

$12,580.00

Hospital Charge Code	270668858
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

PATELLOFEMORAL LEFT SZ 8

Facility

$12,580.00

Hospital Charge Code	270668859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL LEFT SZ 8

Facility

$12,580.00

Hospital Charge Code	270668859
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

PATELLOFEMORAL RIGHT SZ 2

Facility

$12,580.00

Hospital Charge Code	270668860
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL RIGHT SZ 2

Facility

$12,580.00

Hospital Charge Code	270668860
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

PATELLOFEMORAL RIGHT SZ 3

Facility

$12,580.00

Hospital Charge Code	270668861
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFEMORAL RIGHT SZ 3

Facility

$12,580.00

Hospital Charge Code	270668861
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

PATELLOFERMORAL RIGHT SZ 4

Facility

$12,580.00

Hospital Charge Code	270668862
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

PATELLOFERMORAL RIGHT SZ 4

Facility

$12,580.00

Hospital Charge Code	270668862
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

PATELLOFERMORAL RIGHT SZ 5

Facility

$12,580.00

Hospital Charge Code	270668863
Hospital Revenue Code	278
Min. Negotiated Rate	$357.27
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$397.53
Rate for Payer: Wellpoint Medicaid Managed Care	$357.27

Know your out-of-pocket cost for care.

All Charges