Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PSN REV TIB FIX KNEE L CMT SZF

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270697457
Hospital Revenue Code	278
Min. Negotiated Rate	$541.52
Max. Negotiated Rate	$9,533.75
Rate for Payer: Aetna Commercial	$7,245.65
Rate for Payer: Aetna Medicare Advantage	$5,720.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,862.21
Rate for Payer: Cigna Commercial	$9,533.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12
Rate for Payer: UnitedHealthcare Community & State	$602.53
Rate for Payer: Wellpoint Medicaid Managed Care	$541.52

PSN REV TIB FIX KNEE L CMT SZF

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270697457
Hospital Revenue Code	278
Min. Negotiated Rate	$2,860.12
Max. Negotiated Rate	$4,614.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12

PSN REV TIB FXD KEEL CMT SZF/R

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270699725
Hospital Revenue Code	278
Min. Negotiated Rate	$541.52
Max. Negotiated Rate	$9,533.75
Rate for Payer: Aetna Commercial	$7,245.65
Rate for Payer: Aetna Medicare Advantage	$5,720.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,862.21
Rate for Payer: Cigna Commercial	$9,533.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12
Rate for Payer: UnitedHealthcare Community & State	$602.53
Rate for Payer: Wellpoint Medicaid Managed Care	$541.52

PSN REV TIB FXD KEEL CMT SZF/R

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270699725
Hospital Revenue Code	278
Min. Negotiated Rate	$2,860.12
Max. Negotiated Rate	$4,614.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12

PSN REV TIB HALF BLACK SZ

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270690587
Hospital Revenue Code	278
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

PSN REV TIB HALF BLACK SZ

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270690587
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

PSN REV TIB HALF BLK SZCD 10MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270697322
Hospital Revenue Code	278
Min. Negotiated Rate	$233.70
Max. Negotiated Rate	$4,114.38
Rate for Payer: Aetna Commercial	$3,126.93
Rate for Payer: Aetna Medicare Advantage	$2,468.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,098.33
Rate for Payer: Cigna Commercial	$4,114.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31
Rate for Payer: UnitedHealthcare Community & State	$260.03
Rate for Payer: Wellpoint Medicaid Managed Care	$233.70

PSN REV TIB HALF BLK SZCD 10MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270697322
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.31
Max. Negotiated Rate	$1,991.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31

PSN REV TIB HALF BLOCK 10MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270697332
Hospital Revenue Code	278
Min. Negotiated Rate	$233.70
Max. Negotiated Rate	$4,114.38
Rate for Payer: Aetna Commercial	$3,126.93
Rate for Payer: Aetna Medicare Advantage	$2,468.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,098.33
Rate for Payer: Cigna Commercial	$4,114.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31
Rate for Payer: UnitedHealthcare Community & State	$260.03
Rate for Payer: Wellpoint Medicaid Managed Care	$233.70

PSN REV TIB HALF BLOCK 10MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270697332
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.31
Max. Negotiated Rate	$1,991.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31

PSNREV TIB HALFBLOCK SZEF 10MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694632
Hospital Revenue Code	278
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

PSNREV TIB HALFBLOCK SZEF 10MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694632
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

PSN REV TIBHALFBLOCKSZEFRL10MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694633
Hospital Revenue Code	278
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

PSN REV TIBHALFBLOCKSZEFRL10MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694633
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

PSNREVTIBINSCCKVE18MMR3-5CD

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270695262
Hospital Revenue Code	278
Min. Negotiated Rate	$514.75
Max. Negotiated Rate	$9,062.50
Rate for Payer: Aetna Commercial	$6,887.50
Rate for Payer: Aetna Medicare Advantage	$5,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,621.88
Rate for Payer: Cigna Commercial	$9,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75
Rate for Payer: UnitedHealthcare Community & State	$572.75
Rate for Payer: Wellpoint Medicaid Managed Care	$514.75

PSNREVTIBINSCCKVE18MMR3-5CD

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270695262
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.75
Max. Negotiated Rate	$4,386.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

PSN REV TM TIB CENTRAL CONE SZ

Facility

$38,280.00

Service Code	HCPCS C1776
Hospital Charge Code	270700106
Hospital Revenue Code	278
Min. Negotiated Rate	$5,742.00
Max. Negotiated Rate	$9,263.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,656.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,263.76
Rate for Payer: Qualcare PPO/HMO/WC	$5,742.00

PSN REV TM TIB CENTRAL CONE SZ

Facility

$38,280.00

Service Code	HCPCS C1776
Hospital Charge Code	270700106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.15
Max. Negotiated Rate	$19,140.00
Rate for Payer: Aetna Commercial	$14,546.40
Rate for Payer: Aetna Medicare Advantage	$11,484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,761.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,761.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,656.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,761.40
Rate for Payer: Cigna Commercial	$19,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,263.76
Rate for Payer: Qualcare PPO/HMO/WC	$5,742.00
Rate for Payer: UnitedHealthcare Community & State	$1,209.65
Rate for Payer: Wellpoint Medicaid Managed Care	$1,087.15

PSN SM CR VE ASF 12MM 8-11

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699476
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN SM CR VE ASF 12MM 8-11

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699476
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

PSNSTEMREV3MMOFFSETEXT11X135MM

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270695263
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$4,561.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

PSNSTEMREV3MMOFFSETEXT11X135MM

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270695263
Hospital Revenue Code	278
Min. Negotiated Rate	$535.34
Max. Negotiated Rate	$9,425.00
Rate for Payer: Aetna Commercial	$7,163.00
Rate for Payer: Aetna Medicare Advantage	$5,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,806.75
Rate for Payer: Cigna Commercial	$9,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50
Rate for Payer: UnitedHealthcare Community & State	$595.66
Rate for Payer: Wellpoint Medicaid Managed Care	$535.34

PSNSTEMREV3MMOFFSETEXT12X135MM

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270695261
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$4,561.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

PSNSTEMREV3MMOFFSETEXT12X135MM

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270695261
Hospital Revenue Code	278
Min. Negotiated Rate	$535.34
Max. Negotiated Rate	$9,425.00
Rate for Payer: Aetna Commercial	$7,163.00
Rate for Payer: Aetna Medicare Advantage	$5,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,806.75
Rate for Payer: Cigna Commercial	$9,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50
Rate for Payer: UnitedHealthcare Community & State	$595.66
Rate for Payer: Wellpoint Medicaid Managed Care	$535.34

PSNSTEMREV3MMOFFSETEXT17X135MM

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270695146
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$4,561.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

Know your out-of-pocket cost for care.

All Charges